فهرست مطالب

Caspian Journal of Internal Medicine
Volume:12 Issue: 3, Summer 2021

  • تاریخ انتشار: 1400/03/22
  • تعداد عناوین: 18
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  • Javad Ghaffari*, Reza Alizadeh navaei, Abbas Dabaghzadeh, Negar Ghaffari Pages 236-242
    Background

    Asthma is a chronic inflammatory respiratory disorder. Nutritional conditions affect allergic diseases such as asthma. The aim of this study was to review the serum zinc level in children with asthma.

    Methods

    This is a review article found in databases such as Google, PubMed, SID, Irandoc, Scopus and up-to-date. Key words for search included zinc, asthma, children and pediatric. There was no time limitation for the search. These articles on zinc levels in asthmatic children were meta-analyzed.

    Results

    Out of the 40 articles, 19 articles were excluded and 21 articles were included in this analysis. 15 articles evaluated serum zinc levels, 4 articles on hair zinc levels, one article evaluated nail zinc levels and another on zinc level in erythrocyte cells in children with asthma. Only 3 articles evaluated effects of zinc supplement treatment in children with asthma. Meta-analysis of studies showed that there was no significant difference between the standard mean differences of zinc level in asthmatic patients compared to the control group. We cannot analyze the association between zinc levels in hair and nail in children with asthma. All clinical trial studies show that zinc supplement improves clinical manifestations of asthma and patient’s pulmonary function test.

    Conclusion

    We found that the mean serum zinc level difference is not significant in children with asthma than healthy control group and it seems that there is no relation between mean serum zinc level and severity of asthma in children.

    Keywords: Asthma, Children, Zinc, Nutrition
  • Hossein Esfahani, Asadolah Tanasan*, Mina Rezanejad, Saadat Torabian Pages 243-248
    Background

    The most important prognostic factor in transfusion-dependent betathalassemia is cardiac involvement which is usually evaluated with echocardiography.

    Methods

    In this cross-sectional study (April 2011 to April 2012), conventional echocardiography was used to assess myocardial performance and valvular involvement (through transvalvular Doppler study) for right and left heart abnormalities in transfusiondependent beta-thalassemia.

    Results

    Among the 60 patients, 43 cases had heart problems, 26 (43.3%) of them had left myocardial dysfunction and 11 (18.3%) of them had right myocardial dysfunction, 3 cases had both RV and LV myocardial dysfunction, (based on LVMPI & RVMPI, respectively). In patients with right myocardial dysfunction, 4 cases had pulmonary hypertension (PH) and 3 had both sided myocardial dysfunction. LVMPI and RVMPI significantly increased in patients with cardiac involvement (p<0.001). Serum ferritin levels in patients with and without cardiac involvement were 2427±1788 ng/ml and 1573±592 ng/ml, respectively (P=0.008). All 4 patients who had PH, had been splenectomized. In splenectomized and nonsplenectomized patients, LVMPI was 0.37±0.11 and 0.38±0.1 (P=0.589), RVMPI was 0.3±0.07 and 0.25±0.39 (P=0.004), and TR gradient (TRG) was 28±11.8 mmHg and 19.7±5.2 mmHg (P=0.033), respectively. Mean ferritin level in patients with a history of splenectomy (n=31), was 2525±1968 ng/ml and in patients without the history of splenectomy (n=29) was 1821±947 ng/ml (P=0.082).

    Conclusion

    In addition to left-sided heart involvement, conventional echocardiography revealed right-sided heart involvement in transfusion-dependent thalassemia patients which did not correlate with serum ferritin level in splenectomized patients

    Keywords: Beta Thalassemia, Blood Transfusion, Echocardiography, Heart
  • Novin Nikbakhsh, Fatemeh Amri, Mahmood Monadi, Parviz Amri, Ali Bijani Pages 249-255
    Background

    Percutaneous dilatational tracheostomy (PDT) is a common surgical procedure in the ICU. The present study was conducted to compare semi-surgical percutaneous dilatational tracheostomy (SSPDT) with conventional percutaneous dilatational tracheostomy (CPDT).

    Methods

    The present randomized clinical trial was conducted on 160 patients hospitalized in the medical intensive care units (ICUs) with an indication for tracheostomy and were systematically divided into two equal groups of 80. In the CPDT group, after a small incision, a 16-gauge needle was blindly inserted into the trachea and the guidewire was placed inside the lumen. A stoma was created by passing a single dilator over the guidewire. In the SSPDT group, a transverse incision (2 cm) was made 1 cm below the cricoid, and the tracheal ring was then fully reached by releasing the subcutaneous tissues using the index figure, and PDT was then performed. The two groups were compared in terms of their tracheostomy complications (including bleeding, pneumothorax, stoma infection and accidental decannulation) and duration of the procedure.

    Results

    The two groups were homogeneous in terms of age, gender, mean APACHE score (P>0.05). There were no significant differences between the two groups in terms of the mean time from tracheal intubation to tracheostomy (P=0.869). The duration of the procedure was 5.16±1.72 minutes in the SSPDT group and 6.42±1.71 in the CPDT group (P<0.001). The complication rate was 7(8.75%) in the SSPDT group and 16(20%) in the CPDT group (P=0.043).

    Conclusion

    SSPDT is safer and has fewer complications than CPDT in ICU patients.

    Keywords: Intensive care unit, Percutaneous dilatational tracheostomy, Complications
  • Seyed Amir Aledavood, Kazem Anvari, Soodabeh Shahidsales, Sare Hosseini, Ali Emadi Torghabeh, Masume Masudian* Pages 256-262
    Background

    Pre-operative chemoradiotherapy (NACRT) of patients with proximal gastric and esophagogastric junction (EGJ) adenocarcinoma may result in increased local control and improved patients’ survival rate. This study aimed to investigate the effect of NACRT on resectability of tumor in patients with proximal gastric and EGJ adenocarcinoma.

    Methods

    In this single-arm clinical trial, patients with locally advanced proximal gastric and EGJ adenocarcinoma were included. Two courses of paclitaxel/carboplatin chemotherapy alone followed by NACRT with a similar treatment regimen and a total radiation dose of 45-50.4/1.8-2 Grays were prescribed. After surgery, patients were evaluated for resection rate, pathologic response rate, and post-surgical complications.

    Results

    A total of 61 patients with a mean age of 65.9 years participated. Grades 1 and 2 were the most prevalent side effects, with grade 3 being the worst grade and exhibiting as leukopenia (4.9%) and thrombocytopenia (1.6%). 25 (41%) patients underwent surgery after NACRT. Post-surgery complication was reported in 20% of cases (including 8% mortality and 12% morbidity). R0 and R2 resection was observed in 88% and 12% of cases, respectively. Complete pathologic-response was achieved in 24% of patients.

    Conclusion

    Paclitaxel/carboplatin based neoadjuvant chemotherapy was associated with potential resectability and appropriate pathologic response in patients with locally advanced proximal gastric and EGJ adenocarcinoma. However, by reducing patient tolerance to complete courses of weekly chemotherapy, induction chemotherapy lowered the effectiveness of concurrent chemotherapy and radiotherapy (as a sensitizing agent). Hence, induction chemotherapy proved to be more unbeneficial causing delayed treatment and reducing concurrent chemoradiotherapy tolerance.

    Keywords: Neoadjuvant chemoradiotherapy, Proximal gastric adenocarcinoma, Esophagogastric junction (EGJ) adenocarcinoma
  • Azimi, Shahrokh Karbalai Saleh, Masoud Etemadifar, Vahid Shaygannejad, Fereshteh Ashtari, MohammadHossein Harirchian, Bahaadin Siroos, Hormoz Ayramloo, Nastaran Majdinasab, Seyyed MohammadMasood Hojjati, Nabiollah Asghari Pages 263-274
    Background

    Fingolimod was the first oral therapy approved for treating relapsingremitting multiple sclerosis (RRMS) in 2010. This open-label study evaluated the safety and efficacy of fingolideR , 0.5 mg in Iranian MS patients during one-year follow-up.

    Methods

    A multicenter, open-label, longitudinal was designed to evaluate the safety and efficacy of fingolideR , 0.5 mg over a one-year follow-up period across 11 centers. The patients were visited by their neurologists every two months to evaluate possible adverse events and clinical disease activity considered by recording Kurtzke’s Expanded Disability Status Scale (EDSS).

    Results

    A total of 252 patients with the mean treatment duration of 343±45.70 days were. 20 patients experienced adverse events (AEs) and serious adverse events (SAEs) such as resistant urinary tract infection (UTI), premature atrial contraction (PAC), skin allergic reaction, macular edema, chicken pox, zona, panic attacks, and exacerbations associated with steroids treatment, all of which led to FingolideR discontinuation. The mean EDSS decreased from (2.15±1.29, 95%CI: 1.99to2.32) at baseline to (1.85±1.22, 95%CI: 1.68to2.02) at 12th month (final visit) while a p-value revealed significant differences comparing baseline and final EDSS (p<0.001). Mean annualized relapse rate (ARR) of the patients in one year prior to the study was (0.006±0.016, 95%CI: 0.004to0.008) which changed to (0.005±0.016, 95%CI: 0.003to0.007) at the end of the study period. Patients with a 12-month period of fingolideR treatment experienced sustained ARR and disease progression (p<0.001).

    Conclusion

    The obtained findings suggest that the administration of FingolideR , 0.5 mg (Fingolimod, Osvahpharma, Tehran, Iran) is safe and efficient for Iranian MS patients.

    Keywords: Fingolimod, Multiple Sclerosis, Safety, Efficacy, EDSS
  • MohammadAli Jahani, Zohreh Alinasab, Maysam Rezapour, Melodi Omrani Nava, Ghahraman Mahmoudi Pages 275-282
    Background

    Despite the development of their prevention and treatment, infectious diseases cause high mortality, many disabilities and inadequate living conditions worldwide. The aim of this study was to evaluate the pattern of infectious diseases in northern Iran with an approach to internal medicine management.

    Methods

    This cross-sectional research was conducted in 2019 on all 7095 infectious diseases patient records that referred to Ghaemshahr Razi Hospital, Mazandaran Province, Iran during 2012-2018. A checklist prepared by investigator was used to collect the data. The extracted data were coded and entered into SPSS 22 and analyzed using K2 and independent t-test at p<.05.

    Results

    The mean age of the study patients was 29.7±26.4. 4372 (61%) of the cases were males and the mean duration of hospitalization was 41.6±33.5. Age was significantly correlated to infectious diseases (P=.001). Gastroenteritis was the most common infectious disease among the men and women with 2442 (60.5%) and 1594 (39.47%), respectively. Based on the Pearson's correlation test, the relationship between leptospirosis, brucellosis, pulmonary tuberculosis, shigellosis, sepsis and infectious mononucleosis with gender, habitation, admission mode, discharged mode and age was significant (p<.05).

    Conclusion

    As the high frequent diseases were gastroenteritis, leptospirosis, brucellosis and sepsis and an increasing trend was in the prevalence of gastroenteritis, leptospirosis and lung tuberculosis, health system managers should consider training courses, preventive strategies, real-time interventions, increased hospital bed rate for patients with infectious diseases and so on.

    Keywords: Contagious, Infectious diseases, Disease process, Infectious
  • Fatemeh Sari Aslani, Mozhdeh Sepaskhah, Akbar Safaei, Seddigheh Jashounia Hormozi Pages 283-289
    Background

    Cutaneous pseudolymphoma can histologically and clinically simulate various types of cutaneous lymphoma. We conducted the current study to evaluate the clinicopathological and immunohistochemical (IHC) aspects of cutaneous pseudolymphoma (PSL).

    Methods

    30 cases of cutaneous PSL were selected from the archives of 2013-2017 in Shahid Faghihi Hospital pathology lab, Shiraz University of Medical Sciences. Available clinical data, histopathological features and IHC findings were statistically analyzed.

    Results

    The female: male ratio was 2:1 and the median age was 47±14.9 years. The lesions were located on the head and neck 26 (86.7%), trunk 2 (6.7%) and extremities 2 (6.7%). 23 (76.7%) cases had nodular pattern, while 7 (23.3%) showed diffuse pattern. The grenz zone was seen in 24 (80%) cases. Sixteen (53.3%) cases showed top heavy infiltration, 11 (36.7%) showed the same distribution of infiltration at the superficial and deep dermis, often involving the subcutaneous fat and 3(10%) showed bottom heavy infiltration. In IHC, 11(36.6%) cases showed the B cell type, 10 (33.3%) T cell type and 9 (30%) mixed type (B and T cells).

    Conclusion

    None of the cases was suspicious for cutaneous lymphoma, applying IHC staining. Gender distribution, and the site of cutaneous lesions were similar to previous studies. The most common histological subtype was nodular, while the B-cell cutaneous pseudolymphoma was slightly more common compared to the T-cell type.

    Keywords: Cutaneous, Pseudolymphoma, Immunohistochemistry
  • Seyed Mohammad Abedi, Alireza Mardanshahi, Reza Zeinali Pages 290-293
    Background

    In this research, we aimed to survey the added value of single photon emission computed tomography (SPECT) in comparison with planar whole body bone scan to visualize bone metastatic lesions in patients with breast cancer.

    Methods

    A total of 80 patients with breast cancer (invasive ductal carcinoma) were examined with planar whole body bone scan and SPECT imaging using 99mTc-labelled methylene diphosphonate (99mTc-MDP). The patients with abnormal uptakes in SPECT imaging were also investigated with magnetic resonance imaging (MRI).

    Results

    Among these 80 patients with normal whole body bone SPECT scan, 19 (23.25%) of them revealed abnormal 99mTc-MDP uptake in skeleton. Furthermore, these 19 patients were subjected to MRI and 3 (3.75%) of them were confirmed with metastatic bone lesion.

    Conclusion

    The obtained data suggest that SPECT possess the added diagnostic over planar whole body bone scan.

    Keywords: 99mTc-MDP, SPECT, Whole body bone scan, Breast cancer, Bone metastasis
  • Lingga Suryakusumah, Nur Ahmad Tabri, Sahyuddin Saleh, Syakib Bakri, Hasyim Kasim, Andi Fachruddin Benyamin, Erwin Arief, Arifin Seweng Pages 294-298
    Background

    Tuberculosis (TB) is an infectious disease caused by mycobacterium tuberculosis (Mtb). This infection causes the release of proinflammatory cytokines that affect hemostasis. Pulmonary TB infection causes an increased activation of procoagulant factors, decreased anticoagulant factors and suppresses fibrinolysis which causes hypercoagulable. Our study is conducted to assess the association between pulmonary TB infection (PTB) with hemostatic parameters before and after intensive phase treatment.

    Methods

    This was an analytic observational prospective cohort design. The study was conducted at the Community Center for Lung Health in South Sulawesi. Studied subjects were recruited by consecutive sampling, in which the patients who met the inclusion criteria received intensive phase of ATD treatment. PT, aPTT, fibrinogen, and D-dimer were measured before treatment and after the intensive phase of ATD. These data were analyzed using the SPSS Version 22.

    Results

    In this study, 30 subjects are new cases of PTB. Prothrombin time, aPTT and Ddimer levels were higher in far advanced lesions and smear-positive sputum group (p<0.001). There was a significant level decrease in PT, aPTT, fibrinogen, D-dimer after intensive phase treatment (p<0.001).

    Conclusion

    Pulmonary tuberculosis infection is associated with hypercoagulability which is characterized by an increase in hemostatic parameters and has significant improvement after intensive phase of ATD treatment.

    Keywords: Pulmonary tuberculosis, Hemostatic parameters, Hypercoagulability
  • Seyed hossein Hamidi, Ghasem Faghanzadeh ganji, Ali Baghaeian, Ali Bijani, Roghayeh Pourkia Pages 299-306
    Background

    Atrial fibrillation is an arrhythmia that results from abnormal depolarization of the atrium. Atrial fibrillation occurs in 5–40% of patients with cardiovascular bypass surgery, usually occurs on 2 to 4 days postoperatively. The aim of this study was Effect of variability of central venous pressure values to prevent atrial fibrillation after coronary bypass grafting.

    Methods

    The present clinical trial study was performed on 150 patients undergoing cardiac surgery referred to Ayatollah Rohani Hospital of Babol. Patients were divided into 3 groups, with normal range pressure (8 to 12 mmHg), low pressure (less than 8), high pressure (greater than 12) based on central venous pressure measurements. Patients were evaluated every 4 hours to 72 hours for central venous pressure, AF incidence and urine output. Finally, the data are analyzed by spss statistical software.

    Results

    In this study 79 (52.7%) patients were male and 71 (47.3%) were female. In examining changes in central venous pressure, the time effect also significantly increased central venous pressure. The results of independent t-test showed that the mean of central venous pressure changes in subjects with at day 16, second day at 16, 20, 24, third day at 4, 8, 12, 16, 20 and 24 hours Atrial fibrillation. Significantly more than those without atrialfibrillation (P<0.05).

    Conclusion

    In the study, central venous pressure changes the effect of time significantly increases the central venous pressure. Individuals with atrial fibrillation also had significantly greater central venous pressure changes than those without atrial fibrillation.

    Keywords: Central venous pressure, atrial fibrillation, coronary by pass grafting
  • Maryam Chehrehgosha, Mahtab Alizadeh Khoei, Nasser Behnampour, Farshad Sharifi, Reza Fadayevatan, Reyhaneh Aminalroaya Pages 307-314
    Background

    Frailty is accompanied by serious health complications in the elderly, especially during hospitalization. Visual scales have been designed for quick and easy evaluation of frailty in different cultures and settings. Therefore, this study aimed to define the accuracy of the Pictorial Fit Frail Scale (PFFS) for frailty screening in the hospitalized elderly in Iran.

    Methods

    This cross-sectional study was conducted on 304 hospitalized participants, aged 65-85 years old admitted at Ziaeian Hospital (Tehran) were enrolled through the inclusion criteria from August to December 2019. All participants were evaluated based on the Minimum Data Set-Home Care, the Pictorial Fit Frail Scale, and the Quality-of-Life instrument, through face-to-face interviews by a trained nurse at the admission time. Spearman’s correlation coefficient, and ROC analysis were performed using SPSS at p<0.05.

    Results

    The highest correlation was obtained by Frailty Index (FI) and PFFS (0.770). FI had a negative correlation with QoL (-0.48). The optimal cut-points for PFFS according to FI ≤ 0.08 (robust vs. pre-frail) was obtained 0.10 with sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy 100.00% and the best cut-point for PFFS based on FI ≥ 0.25 (pre-frail vs. frail) was obtained 0.29 with sensitivity and specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy 100.00%.

    Conclusion

    It seems the Pictorial Fit-Frail Scale (PFFS) is a reliable scale with a high level of accuracy, and excellent sensitivity and specificity to measure the frailty level in hospitalized elderlies.

    Keywords: Frailty, Pictorial Fit Frail Scale, MDS-specific frailty index, Hospital, ROCCurve
  • Razieh Ehsani, Morteza Alijanpour, Mohammadreza Salehiomran, Farzan Kheirkhah, Leila Moslemi, Faeze Aghajanpour Pages 315-322
    Background

    Congenital hypothyroidism (CH) is one of the most common endocrine diseases and one of the major causes of mental retardation in children. So we aimed to evaluate the developmental outcome of children with CH.

    Methods

    This case-control study was performed on two 3-6-year-old groups of 100 patients. The case group was children with CH, referred to Endocrine Clinic of Amirkola Children's Hospital (2011-2017) and the control group was healthy children and normal from other states. The Denver developmental screening test-II (DDST_II) was used to assess the developmental factors and disorders in four areas of gross motor, fine motor, personalsocial and language. Data were analyzed by SPSS 21 using descriptive statistics, t-test and chi-square, and a p<0.05 was considered significant.

    Results

    The mean age of 200 children in the case and control groups was 54.62±15.72 and 59.68±15.64 months, respectively. In the case group, 45% and 55% of them had transient and permanent CH, respectively. All four criteria of DDST_II in the control group as well as gross motor in the case group were normal, but fine motor, personal-social and language were reported normal in 94, 95 and 93% of the case group, respectively. All subjects with abnormal DDST_II, had a negative neonatal screening tests.

    Conclusion

    The results obtained from DDST_II indicated that 6% of children with CH had an abnormal development, all who had an onset of medical treatment over 30 days, which makes it important to screen the neonatal thyroid disease and diagnose this disease timely

    Keywords: Developmental outcome, Congenital hypothyroidism, Pediatrics, DenverDevelopmental Screening Test II
  • Erny Puti, Haerani Rasyid, Pendrik Tandean, Himawan Sanusi, Hasyim Kasim, Syakib Bakri, Makbul Aman, Arifin Seweng Pages 323-326
    Background

    Both clinical and experimental evidence have been published over the past few decades supporting the existence of a close relationship between the elevated levels of serum uric acid with cardiovascular events and acute kidney injury (AKI). This study aimed to determine the effect of serum uric acid levels on the incidence of AKI in acute coronary syndrome (ACS) patients.

    Methods

    A retrospective cohort study with a cross sectional design was performed. The research was conducted at Dr. Wahidin Sudirohusodo Hospital from October 2019 to December 2019. Nonrandom sampling was employed in the medical records. All patients who met the inclusion criteria were at > 18 years old and diagnosed with ACS with AKI. The demographic data of age, sex and serum uric acid levels were recorded. The data obtained were analyzed using the SPSS (Statistical Package for Social Sciences).

    Results

    There were 158 subjects of ACS patients with AKI and 135 without AKI. There was a significant correlation between high uric acid levels with the incidence of AKI in ACS (p<0.001). Patients with high serum uric acid levels were 9.5 times at risk of developing AKI compared to those with normal serum uric acid levels.

    Conclusion

    High uric acid level is one of the risk factors for AKI in ACS and indicates 9.5 times at risk of developing AKI compared to normal serum uric acid level. Therefore, it is necessary to monitor serum uric acid level and kidney function in ACS patients.

    Keywords: Acute kidney injury, Acute coronary syndrome, Uric acid
  • Alipasha Meysamie, Reza Ghalehtaki, Saeed Ghodsi, Mehrnaz Mohebi, Shirin Ghalehtaki, Fereshteh Salarvand, Zahra Hosseini, Seyed Ali Sadre Bafghi Pages 327-335
    Background

    Theoretically, smoking status should be associated with metabolic syndrome. This relationship has not been studied in Iranian population so far. This study aimed to explore the association among cigarette smoking, metabolic syndrome (MetS) and its domains in a nationally representative sample of Iranians aged 25-64.

    Methods

    Information of participants regarding demographic data and smoking habits gathered through WHO STEPS questionnaires in the frame of fourth national surveillance of the risk factors of non-communicable diseases in 2011 across the country. The fasting plasma glucose, triglyceride level, high-density lipoprotein cholesterol (HDL-C) level, blood pressure, and anthropometric indices in each patient were measured. Data of 4000 subjects were analyzed with complex sample survey method. The prevalence of metabolic syndrome was assessed according to two definitions: International Diabetes Federation (IDF) and Iranian definition.

    Results

    Herein, 38.4% of smoker participants and 36.6% of non-smokers met the IDF criteria for MetS (P=0.67). Similarly, 31.1% of smokers and 34.1% of non-smokers had MetS according to Iranian-IDF (P=0.427). Only in univariate analysis, using IDF criteria female smokers had lower prevalence of MetS than non-smokers (13.9% vs. 36.5%, P=0.01). Multivariate analysis determined the following odds ratios for the association of smoking with MetS defined by IDF and Iranian-IDF criteria, respectively: OR= 0.89 (0.53- 1.47), P=0.638 and OR= 0.97 (0.59-1.58), P=0.901.

    Conclusion

    There was no significant association between smoking and MetS overall and among men. However, smoking was associated with lower prevalence of MetS among women.

    Keywords: Metabolic syndrome, Smoking, Adult, Complex samples, Central obesity, Prevalence, Risk factor, Iran
  • Zinatossadat Bouzari, Ebrahim Alijanpour, Shahla Yazdani, Azita Ghanbarpour, Ali Bijani, Tahereh Ashraf Ganjoei, Hemmat Gholinia Pages 336-341
    Background

    The purpose of the study was to evaluate the effectiveness and safety of thermal balloon ablation in women with high anesthetic and surgical risk compared to invulnerable women according to the American Society of Anesthesia (ASA) physical status stratification.

    Methods

    This report was based on a retrospective cohort study of women with heavy menstrual bleeding (HMB) who were eligible for treatment with CavatermTM plus during 2012-2017. Women were classified as high-risk (HR) or low-risk (LR) cohorts based on ASA physical status stratification. The primary outcome includes amenorrhea in the twelfth months after the treatment. Risk adjustments were performed using regression models.

    Results

    This research study consisted of 63 women with mean age 44.42±5.48. Mean of body mass index (BMI) in the HR cohort was higher than the LR cohort (31.48±6.22 vs 26.83± 3.51, P=0.005) and results were also similar considering the uterine length (mm) between HR and LR women (58.27±35.70 vs 30.92± 35.30, P=0.01). The primary outcome of treatment after a one-year follow-up in the two groups (HR and LR) was 31 (93.9%) and 15 (78.9%), respectively. After adjusting for known confounders including age, uterine length, parity, dysmenorrheal, the adjusted odds ratio was 0.94 (95% CI, 0.14– 2.5; P= 0.60).

    Conclusion

    For women with high anesthetic and surgical risks derived from serious underlying co morbidities, endometrial ablation can provide a minimally invasive, safe, and effective therapy for heavy menstrual bleeding.

    Keywords: : Endometrial ablation, Menorrhagia, Amenorrhea, Recovery, Anesthesia, Obesewomen
  • Fatemeh Eshaghi Gorji, Maryam Seyedmajidi, Fariba Asgharpour, Hamed Tashakorian, Aliakbar Moghadamnia, Sohrab Kazemi, Homayoon Alaghehmand Pages 342-349
    Background

    This study aimed to assess the effect of graphene oxide (GO) nanoparticles mouthwash on oral mucosa, Streptococcus mutans (S. mutans) count in the saliva of rats, and human enamel surface microhardness, in comparison with fluoride mouthwash.

    Methods

    This study was conducted in two phases namely an animal study, and an in vitro experimental study. GO mouthwash (0.005%), sodium fluoride (NaF) mouthwash (0.05%), and a combination of both (0.05% NaF-0.005% GO) were prepared. The oral cavity of 36 rats was inoculated with S. mutans, and they were randomly divided into 4 groups according to the type of mouthwash. The control group received saline mouthwash. Fourteen days after using the mouthwashes, all rats were sacrificed, and the salivary S. mutans count was measured. The buccal and tongue mucosa were also histologically examined for the type and severity of inflammation, number of blood vessels, epithelial thickness, and epithelial keratinization. For microhardness testing, 40 sound extracted human premolars were randomly assigned to four groups (n=10) of culture medium with S. mutans and different mouthwashes. The enamel microhardness was measured at 7 and 14 days, and compared with the baseline value.

    Results

    The mean S. mutans count in the saliva of rats in GO and NaF-GO groups was significantly lower than that in other groups (p<0.001). Enamel microhardness in NaF and NaF-GO groups significantly increased at 7 and 14 days, compared with baseline.

    Conclusion

    Addition of GO nanoparticles improved the antibacterial properties without causing adverse mucosal effects such as ulceration, acute inflammation or atrophy of the epithelium of the oral mucosa, but had no effect on surface hardness of the enamel.

    Keywords: Nanoparticles, Streptococcus mutans, Sodium fluoride
  • Mohammad Ghorbani, Ebrahim Hejazian, Eshagh Bahrami, Abolghasem Mortazavi, Reza Bahrami, Nazila Farnoush Pages 350-355
    Background

    Treatment of complex wide neck brain aneurysms is a challenging era in neurosurgery. Both surgical and endovascular therapies are considered for treatment of them. In endovascular, there are different ways such as trapping, coiling, stent and balloon assisted coiling. In this study, we use flow-diverter devices to create new vascular lumen and then coiling the aneurysm sac for three patients.

    Methods

    We describe three cases with complex cerebral aneurysm who were treated successfully by flow diverter-coil technique and point to technical nuances.

    Results

    In our patients, wide neck aneurysms, two in distal part of ICA (internal carotid artery) and other in basilar tip. We use flow-diverter-coil technique successfully. On the follow-up, aneurysms are treated completely without any complications.

    Conclusion

    We think flow diverter devices adjunct to coiling is a useful way for the treatment of complex wide neck cerebral aneurysms.

    Keywords: Complex wide neck brain aneurysms, Flow diverters, Coil, Treatment
  • Mohammadreza Naderian, Ali Sheikhy, Seyed Mojtaba Ghorashi, Masih Tajdini, Saeed Sadeghian, Kaveh Hosseini Pages 356-358