Sinusitis is a common disease with harmful effects on the health and finances of patients and the economy o the community. It is easily treated in most of its acute stages but is associated with some management difficultie as it goes toward chronicity. Therefore, we tried to improve the treatment of subacute sinusitis by using acetylcysteine, which is a safe mucolytic and antioxidant agent. Thirty-nine adult patients with subacute sinusitis proved by computed tomography (CT) were enrolled in a double-blind, placebo-controlled trial. They received oral amoxicillin-clavulanic acid and normal saline nasal drops for 10 days and oral pseudoephedrine for 7 days In addition, the patients received acetylcysteine (600 mg orally, once daily) in the intervention group or placebo in the control group for 10 days. A paranasal CT scan was taken at baseline and 30 days after patients finished the treatment and was evaluated quantitatively by Lund- Mackay (LM) score. Symptoms and some aspects of quality of life also were assessed at baseline and 14 days after initiation and 30 days after termination of the treatment via the Sino-Nasal Outcome Test questionnaire. The groups showed no significant difference in LM score after treatment. A positive correlation was observed between the LM and SNOT-20 scores. We concluded that adding oral acetylcysteine to amoxicillin-clavulanic acid, pseudoephedrine, and intranasal normal saline has no benefit for the treatment of subacute sinusitis. DOWNLOAD
Background: The Acute Physiology and Chronic Health Evaluation (APACHE) II is still commonly used as an index of illness severity in patients admitted to intensive care unit (ICU) and has been validated for many research and clinical audit purposes.
Aims and objectives: To investigate the diagnostic value of the APACHE II score for predicting mortality rate of critically ill patients.
Design: This was a single-centre, retrospective study of 200 Iranian patients admitted in the medical–surgical adult ICU from June 2012 to May 2013. Methods: Demographic data, pre-existing comorbidities and variables required for calculating the APACHE II score were recorded. Receiver operating characteristic (ROC) curves were constructed, and the area under the ROC curves was calculated to assess the predictive value of the APACHE II score.
Results: Of the 200 patients with a mean age of 55⋅27±21⋅59 years enrolled in the study, 112 (54%) were admitted in the medical ICU and 88 (46%) in the surgical ICU. Finally, 116 patients (58%) died, and 84 patients (42%) survived. The overall actual and predicted ICU mortality were 58% and 25⋅16%, respectively. The mean APACHE II score was 16⋅31 in total patients, 17⋅78 in medical ICU and 14⋅45 in surgical ICU patients (P =0⋅003). Overall, the APACHE II score had the highest prognostic value for predicting the mortality rate of critically ill patients with an area under the cure of 0⋅88, and with a cut-off value of 15, the APACHE II score predicted mortality of patients with a sensitivity of 85⋅3%, a specificity of 77⋅4%, a positive predictive value of 83⋅9% and a negative predictive value of 73⋅9%.
Conclusion: This study shows that an APACHE II score of 15 provides the best diagnostic accuracy to predict mortality of critically ill patients. Our observed mortality rate was greater than the predicted death rate, in comparison to the other prestigious centres in the world. Therefore, it appears that we must improve our intensive care to reduce mortality.
Relevance to clinical practice: There is a need to create a suitable scoring system to predict the mortality rate of critically ill patients in accordance with the advanced technological equipment and experienced physicians and nurses in that ICU.DOWNLOAD
In this paper, we measured the levels of metals including Pb, Cr, Cd, Ni, Hg, Fe, and Cu in the inlet and outlet wastewater of hospitals. The samples were taken from wastewater in Bushehr’s province hospitals, Iran. After the collection of samples, the concentration levels of metals were determined by using graphite furnace absorption spectrometer (AAS) method (Varian, SpectrAA 240, Australia). Statistical analysis of the data was carried out using Special Package for Social Sciences (SPSS 16). DOWNLOAD
To evaluate clinical utility of rapid urease test (RUT), brush cytology and histology for detecting Helicobacter pylori.
Brush cytology materials were obtained from the antrum of the stomach in 109 patients who suffered from dyspepsia and were candidates for endoscopy. RUT and histology with hematoxylin-eosin staining were performed. Infection status was established by observation of typical HP in cytology or biopsy. DOWNLOAD
A rare case of ileal duplication in a 6-year-old boy is presented. The duplicated area is just like an additional ectopic stomach both in radiologic and pathologic examination. The patient was operated on because of intestinal obstruction. DOWNLOAD
Background: We evaluated factors that affect malignant transformation of leukoplakia in a sample of the Iranian population.
Methods: The records of patients with a clinical diagnosis of leukoplakia during a 20-year period from 1989-2009 referred to two of the largest referral centers in southern Iran were studied. Patients that developed malignant trans formation were compared with patients that did not have malignant changes.
Results: Of 522 patients, female patients, those over 50 yr old and with lesions located on the tongue had the highest rate of malignant changes. Female patients with malignant changes were mostly non-smokers (76.4%), while male pa tients with malignant changes were mostly smokers (63.8% in non-smokers) (P<0.001). In our univariate analysis, male sex and smoking showed lower chances for malignant transformation (OR: 0.57; CI=0.397-0.822 and OR: 0.025; CI=0.141-0.299, respectively), while age above 50 was arisk factor for malignant transformation (OR: 3.57; CI=2.32-5.42). In the multivariate analysis, smoking (OR: 0.317; 95% CI=0.16–0.626) and morphological presentation as eryt-hroplakia (OR: 0.025; 95% CI=0.005-0.131) had low chances for developing malignant changes, while site of lesion on the tongue (OR: 774; 95% CI=60-9838) and morphological presentation as erythroleukoplakia (OR: 6.26; 95% CI=3.16-12.38) were a risk factor for developing malignant changes
Conclusion: A follow-up program and further work-up should be considered for Iranian patients who have a leukop-lakia lesion that is flat and are white patch or plaques with red components, in addition for patients who have lesions located on the tongue and for nonsmokers who develops leukoplakia lesions. DOWNLOAD
Background: Epidemiological studies on genital human papilloma viruses infection (HPVs) in general population are crucial for the implementation of health policy guidelines for developing the strategies to prevent the primary and secondary cervical cancer. In different parts of Iran, there is a lack of population-based studies to determine the prevalence of HPV in the general population. The aim of this population-based study is to compare the prevalence rate of genital HPV infection among reproductive women with our previous clinic-based data, which showed a prevalence rate of 5% in women in southern Iran.
Results: Using general primers for all genotypes of HPV, of 799 randomly selected women, five (0.63%, 95% CI 0.23-1.55%) tested positive for HPV DNA. Overall, seven different HPV genotypes were detected: six types (16, 18, 31, 33, 51 and 56) were carcinogenic, or “high risk genotypes” and one genotype (HPV-66) was “probably carcinogenic.”
Conclusions: In a population-based study, the prevalence of HPV infection among southern Iranian women was lower than that observed worldwide. However, our gynaecological clinic-based study on the prevalence of HPV infection showed results comparable with other studies in the Middle East and Persian Gulf countries. Since gynaecological clinic-based data may generally overestimate HPV prevalence, estimates of prevalence according to clinic-based data should be adjusted downward by the population-based survey estimates. DOWNLOAD
Objective: This study was conducted to determine the prevalence and genotype distribution of hepatitis C virus (HCV) infection among patients with type 2 diabetes mellitus (DM).
Subjects and Methods: We included 556 consecutive patients with confirmed type 2 DM attending the Diabetic Clinic of the Bushehr University of Medical Sciences and 733 nondiabetic subjects as controls. Serum levels of fasting blood sugar (FBS), alanine transaminase (ALT), aspartate transaminase (AST), total cholesterol (TCH), and triglycerides (TG) were measured by enzymatic colorimetric methods, and the presence of anti-HCV antibodies was determined by enzyme- linked immunosorbent assay. Semi-nested reverse transcriptase-polymerase chain reaction (RT-PCR) followed by sequencing was performed on all anti-HCV-seropositive samples. Data were analyzed using the Statistical Package for the Social Sciences 17, and descriptive statistics, χ2 test, Fisher exact test, and the Student t test were used for analysis.
Results: The seroprevalence of HCV in the diabetic patients was 1.98% (11/556), which was higher than HCV prevalence among the nondiabetic controls (4/733, 0.54%) (p = 0.032). No significant differences in ALT, AST, FBS, TG, and TCH levels were found between the HCV-seropositive and HCV-seronegative diabetic patients, although HCV seropositive diabetic patients tended to have higher ALT, AST, and TCH levels, but lower TG and FBS levels than HCV seronegative patients. In logistic regression analysis, only AST levels were significantly associated with HCV seropositivity among diabetic patients. The AST level of 41–80 IU/L was the only significant predictive variable for HCV seropositivity in the diabetic patients (odds ratio, 4.89; 95% CI: 1.06–22.49; p = 0.041). Of the 11 HCV-seropositive diabetic patients, 10 (91%) had HCV viremia with genotype 3a.
Conclusion: Patients with type 2 DM had a higher prevalence of HCV infection than controls, and HCV seropositivity was independent of biochemical parameters. DOWNLOAD
Background: Some genotypes of human papillomaviruses can infect the genital tract and they are important infectious agents which their oncogenicity is regardable. Thus the aim of this study was to determine the prevalence of various genital human papillomaviruses (HPV) among women being subjected to routine pap smear test in Bushehr city of Iran.
Results: Based on the collected data, 11(5.5%) samples were detected positive for HPV DNA and 189(94.5%) samples out of 200 samples were detected negative for HPV DNA. Meanwhile 4(2%) samples detected positive for HPV DNA by PCR were detected positive for HPV by pap smear test as well. On the other hand 5 samples which were detected positive for HPV by pap smear test didn’t have HPV DNA after being tested by PCR method. Among the 11 positive samples 7 samples were identified as HPV-16, 3 samples were HPV-18 and one was HPV-53.
Conclusion: Regarding the prevalence of highly carcinogen genotypes of HPV in our study determination of genital HPV prevalence among the normal population of women of Bushehr city is recommended. DOWNLOAD
Background: Although Iran is reported to be an endemic country for hepatitis E virus (HEV), data on the prevalence of HEV infection among pregnant women are scarce and the epidemiology of HEV is unknown in most parts of the country. Therefore, this study was conducted to elucidate the prevalence, risk factors and genotypic pattern of HEV infection among pregnant women resident in the northern shores of Persian Gulf. This is the first report on the epidemiology of HEV infection among pregnant women in this territory.
Methods: From October 2016 to May 2017, 1331 pregnant women participated in this study. The mean age ± SD of participants was 27.93±5.7 years with a range of 14±45 years. Serum samples of pregnant women were screened for the presence of anti-HEV total antibodies, anti-HEV IgG and anti-HEV IgM using commercially available ELISA kits (DIA.PRO, Milan, Italy). All anti-HEV IgG and anti-HEV IgM positive samples were tested for HEV RNA using two independent reverse transcriptase polymerase chain reaction (RT-PCR) assays, targeting ORF2 and ORF3 of HEV genome. In addition, 92 anti-HEV seronegative samples as well as 50 pooled seronegative samples were evaluated by two independent RT-PCR assays for validation of results.
Results: Of the 1331 pregnant women, 84 women (6.3%, 95% CI: 5.1%-7.7%) were positive for anti- HEV antibodies, of which 83 women had anti-HEV IgG, and 11 women (0.83%, 95% CI: 0.47%-1.47%) had anti-HEV IgM. The highest rate of HEV seroprevalence was observed among Afghan immigrants (68.0%), uneducated pregnant women (46.51%) and those residents in Bushehr city (8.75%). All anti-HEV IgG and/or IgM positive samples were found to be negative for HEV RNA. In addition, all of the evaluated anti-HEV seronegative samples were negative for HEV RNA. HEV seropositivity among pregnant women was statistically associated with age, ethnicity, place of residence, number of pregnancies, and level of education. So that, low education levels, Afghan, residence in Bushehr city, age group >34 years, and more parities were risk factors for exposure to HEV. In contrast, HEV seropositivity was not associated with stage of gestation, history of abortion, and time of sampling.
Conclusion: The northern shores of Persian Gulf in Iran, with HEV seroprevalence of 6.3%, can be classified as an endemic geographical region for hepatitis E, and residents of Bushehr city, Afghan immigrants and uneducated women are the main at-risk populations in this territory. DOWNLOAD
A B S T R A C T
Background: An association between metabolic syndrome (MeS) and osteoarthritis (OA) has been reported in recent years; however, conflicting findings have been reported regarding this matter. Inhere we evaluated the relationship between different components of MeS and OA in a Fasa osteoarthritis registry (FOAS).
Methods: The registry includes all OA cases who referred to Fasa hospital (Iran) since 2013. Overall, 131 patients with OA with a Kellgren & Lawrence (K&L) score >1 and 261 controls were compared.
Results: Overall, 82.4% of individuals in the OA group and 40.8% of participants in the control group had MeS (P < 0.001). Patients with OA had a 6.8 (95% CI: 4.1–11.4) higher chance of acquiring MeS. After adjusting for sex, age, and BMI, odds’ ratio (OR) for acquiring MeS in OA group increased to 10.9 (95% CI: 5.5–21.8). Among MeS criteria’s, high waist circumference (WC) has strongest correlation for acquiring OA (OR = 27.535, 95% CI: 6.003–126.306).
Conclusion: Our findings revealed that metabolic markers are strongly associated with OA and the addition of each component of the MeS, significantly increases the risk of developing OA, therefore control of metabolic factors and appropriate screening must be considered in health policy making and prevention programs. DOWNLOAD
Abstract: Extramedullary hematopoiesis is a common compensatory phenomenon to chronic hemolytic anemias. It may be seen in many other conditions including bloody dyscrasias such as leukemia, or as an incidental finding. Common locations of the extramedullary hematopoiesis are liver, spleen, lymph nodes. Spinal cord compression is a rare complication of this entity. We report a spinal cord compression due to extramedullary hematopoiesis. Clinical presentation, diagnosis, and therapeutic options are discussed. DOWNLOAD
Background Scanning with technetium-99m methoxyisobutylisonitrile (99mTc-MIBI) is recommended for evaluating thyroid nodule metabolism. In addition, it may help differentiate between benign and malignant nodules; however, the efficacy of this technique has not been fully elucidated. Therefore, it is not currently performed for routine clinical application. This prospective study was conducted to investigate the clinical significance of 99mTc-MIBI scintigraphy in the assessment of patients with cold thyroid nodules.
Patients and methods This prospective study was conducted on 104 patients with cold thyroid nodules greater than 1 cm in diameter as detected on 99mTc-pertechnetate scintigraphy. Uptake of MIBI in thyroid nodules was compared with that in the surrounding normal thyroid tissue for both early and delayed images, and a score of 0–3 was assigned to each nodule as follows: 0, cold; 1, decreased; 2, equal; 3, increased. The thyroid scan was performed 20 and 40min after intravenous injection of 555MBq of 99mTc-MIBI. The patients underwent fine needle aspiration cytology (FNAC). Detailed statistical parameters were determined on a per-nodule basis for each qualitative and quantitative scan analysis, as defined by histology.
Results A total of 104 patients (93 women and 11 men; mean age 40.76±11.40 years, range 20–73) with a total number of 167 cold nodules were included in this study. When 99mTc-MIBI uptake was regarded as the criterion of malignancy in 99mTc-MIBI scintigraphy, the accuracy was between 69.46 and 92.21% on using seven different methods. In addition, FNAC findings indicated a sensitivity of 66.66%, a specificity of 100%, a negative predictive value of 95.72%, a positive predictive value of 100%, and an accuracy of 96.06%. Six malignant cold nodules were detected on a positive 99mTc-MIBI scan, which were determined as benign nodules on FNAC examinations.
Conclusion The study demonstrated that 99mTc-MIBI scanning can be complementary to other diagnostic techniques in patients with cold thyroid nodules. In addition, because of its availability, rather low cost, simple protocol, and objective semiquantitative information, 99mTc-MIBI scanning seems to hold promise in routine imaging of cold thyroid nodules. DOWNLOAD
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. DOWNLOAD
سونوگرافی با فشار تدریجی، هنگامی که علائم و نشانه های بالینی و همچنین نتایج آزمایشگاهی مبهم هستند، ممکن است در تشخیص آپاندیس حاد بسیار مفید و سودمند باشد. برای تعیین سودمندی سونوگرافی در آپاندیس حاد، یافته های پاتولوژی 164 بیمار آپاندکتومی شده با یافته های سونوگرافی آنان در پیس از عمل جراحی در یک مطالعه آینده نگر، دو سویه کور مورد بررسی قرار گرفتند. تشخیص آپاندیسیت حاد در 113 مورد (68/9 درصد) از طریق هیستوپاتولوژی اثبات شد که 64 نفر (56/6 درصد) از آنها نیز دارای یافته هایی به نفع آپاندیس حاد در سونوگرافی بودند. از 51 بیمار دارای آپاندیس طبیعی، در 40 نفر (78/4 درصد) در سونوگرافی نیز یافته ای به نفع التهاب حاد آپاندیس مشاهده نگردید، حساسیت، ویژگی و دقت سونوگرافی برای آپاندیسیت حاد، به ترتیب 56/6% و 78/4% و 0/63% بود. همچنین ارزش اخباری مثبت و منفی آن به ترتیب 85/3 درصد و 44/49 درصد به دست آمد. بنابراین سونوگرافی، به عنوان یک ابزار کمک تشخیصی مفید، بخصوص در بیماران با علائم و نشانه های گمراه کننده آپاندیسیت حاد، توصیه می شود. دانلود این مقاله
زمینه: کمبود ویتامین D در هنگام بارداری تاثیرات مهمی روی مادر و کودک دارد و کافی بودن این این ویتامین در بارداری برای تنظیم کلسیم، تکامل و میزالیزه شدن استخوان نوزاد لازم دارد. این مطالعه به منظور اندازه گیری سطح سرمی 25 هیدروکسی ویتامین D در مادران شهر بوشهر و بررسیب اثرات آن بر پیامد بارداری انجام شده است.
مواد و روش ها: صد مادر باردار فول ترم از بیمارستان آموزشی وابسته به دانشگاه علوم پزشکی بوشهر در بهار و تابستان سال 1391 انتخاب شدند. نمونه خون در اتاق زایمان گرفته شد و برای اندازه گیری 25 هیدروکسی ویتامین D ، کلسیم، فسفر و پاراتون استفاده شد. 25 هیدروکسی ویتامین D کمتر از 20 نانوگرم در دسی لیتر نشان دهنده کمبود ویتامینD بود.
یافته ها: شیوع کمبود ویتامینD (کمتر از 20 نانوگرم در میلی لیتر) بین مادران مورد مطالعه 76 درصد بود. بین سطح سرمی کلسیم مادر و وزن هنگام تولد نوزاد رابطه معکوس و معناداری وجود داشت(p=0/002 , r = -0/31 ) همچنین میانگین سطح سرمی ویتامین D در دو گروه سنی کمتر و بیشتر از 30 سال تفاوت معنی داری داشت. بین سطح سرمی ویتامین D و پاراتورمون مادر رابطه معکوس و معناداری وجود داست.
نتیجه گیری: توجه به مصرف مقدار کافی کلسیم و ویتامین D هنگام بارداری مهم است. به علاوه به نظر میرسد باید در مورد تجویز ویتامین D به زنان باردار به صورت یک ضرورت فکر کرد. دانلود این مقاله