2023 CiteScore: 0.7
pISSN: 0044-6025
eISSN: 1735-9694
Editor-in-Chief:
Ahmadreza Dehpour, PharmD, PhD
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE).
Vol 51, No 8 (2013)
Original Article(s)
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Cyclin E, HER-2 and p53, are considered as major prognostic markers in breast cancer. As they are related in patho-clinical level, we aimed to check if they have any direct interaction on expression of each other. To study the effect of cyclin E on HER-2 expression, cell lines stably overexpressing cyclin E or its low molecular weight (LMW) isoforms were generated. To understand the results of p53 silencing either alone or in combination with cyclin E overexpression, we created three different p53 stably knocked down cell lines. Protein expression was analyzed by western blot, HER-2 expression in the established cell lines were determined using SYBR green real time PCR and data analyzed by REST software. Results indicate that HER-2 expression is only downregulated following p53 silencing and none of cyclin E isoforms can alter its expression. The presence of cyclin E isoforms in p53 silenced clones also does not altered HER-2 expression. Given the fact that p53 degradation is increased by HER-2 overexpression, these data can draw a regulatory loop in which a non-mutated functional p53 and HER-2 can bidirectionally regulate the expression of these two genes. This study improves our understandings of these pathways and these proteins can be introduced either as a marker or as a target in cancer treatment.
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This study aimed to assess changes in contrast sensitivity and aberrations in cases of myopia greater than 5.0 diopter (D) who had photorefractive keratectomy (PRK). In this semi-experimental study, 20 eyes of ten patients were studied. Inclusion criteria were at least 5.0 D of myopia, stable refraction in the past year, no history of refractive surgery, a minimum corneal thickness of 480 μm, and having surgery in both eyes. Exclusion criteria were the presence of any corneal condition. In addition to the routine tests, aberrometry and assessment of contrast sensitivity was done using the WaveLight Allegro Analyzer and the VectorVision CSV-1000. After PRK using the Concerto Excimer Laser (WaveLight, Alcon), patients were scheduled to have follow-up visits at 1 month, 3 months, and 1 year after surgery. Contrast sensitivity with glare showed an increasing trend only at the spatial frequency of 3 cycles per degree (cpd) (P=0.013). Contrast sensitivity without glared increased postoperatively at special frequencies of 3, 6, and 18 cpd (P<0.05). The preoperative level of higher order aberrations root mean square (HOA RMS) of 0.24±0.08 reached 0.71±0.25 at 12 months after surgery. Assessment of comma and trefoil showed no significant difference between preoperative and postoperative values, but the amount of spherical aberration changed from a mean preoperative value of 0.0±0.09 to 0.27±0.15 at 12 months after surgery. In the treatment of myopia greater than 5.0 D, PRK with the Concerto Excimer Laser can improve contrast sensitivity in certain spatial frequencies. This is while HOA RMS and spherical aberration increase.
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Chronic rhinosinusitis (CRS) is a common disease which is usually diagnosed clinically, considering the combination of natural history, physical examination and imaging studies. This study aimed to evaluate the clinical value of routine postoperative histopathologic examination (POHE) in patients with a clinical diagnosis of chronic rhinosinusitis with polyposis (CRSWP), or without polyposis (CRSWOP One hundred of patients with clinically approved CRSWP and CRSWOP were enrolled in this study. All patients underwent complete physical examination, scoring paranasal sinuses involvement by Lund-Mackay (LM) CT scoring scale, determining the extent of polyposis by Stumberger's endoscopic classification, and assessing health related quality of life by Sinonasal Test 22 (SNOT22) questionnaire. After FESS, histopathologic results were compared with preoperative clinical diagnosis. Among our patients, 65% were male, and the rest of them were female. Also, 66% of them suffered from CRSWP, and the rest of them were CRSWOP. LM CT score and SNOT22 score was 36.62±12, 17.11±6, and 43.62±20 respectively. Only in one of patients with CRSWP, POHE was other than what was expected preoperatively (adenoid cystic carcinoma). In all other cases, POHE was well correlated with preoperative clinical diagnosis. HRQOL was better in males, absence of septal deviation and CRSWOP (P<0.05). Para nasal sinuses involvement in preoperative CT was more severe in the presence of eosinophil in POHE (P=0.008) and in patients with class 3 Stumberger's classification (P<0.001). This study suggested preoperative clinical diagnosis of CRS considering the combination of natural history, physical examination and imaging studies can be accurate, and POHE is indicated only in suspicious cases.
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Simple snoring is a social problem, one that can gravely affect the patient's married life. About 40% of men and 20% of women are affected, and it often goes along with sleep-disordered breathing. Up to now various surgical techniques have been defined such as UPPP(uvulopalatopharyngo plasty), and laser-assisted uvulopalatoplasty (LAUP). Among the surgical methods, RAUP (radiofrequency assisted uvulopalatoplasty) is a minimal invasive, an easy performed, and time and cost effective one. We designed a before and after a clinical trial. The inclusion criteria were age >18 years, complaint of nocturnal snoring, have a bed partner to assess snoring, AHI<5 events per hour in the polysomnography, malampathy score (soft palate position) I or II, an elongated uvula, grade I and II of pharyngeal webbing and patient consent was needed too. A 10-score visual analog scale (VAS) of snoring severity was completed by bed partner. All of 35 included patients underwent RAUP under local anesthesia by the same expert surgeon. After 3 months, 6 months and one year, subjective snoring decreased significantly compared to the preoperative period. The decline in VAS in 6 month compared to 3 months postoperatively, was not significant (P=0.223). When comparing 1 year and 6 months after treatment, the VAS scores were increased, but they were not significant (From 1.8 to 1.9, P=0.78). Three months after treatment minor complications consisted of: nasal regurgitation in 2 patients (5.7%), nasal speech in 2 (5.7%) and exacerbation of snoring in 2 (5.7%) patients.There was no major complication including mucosal laceration, uvular damage and obstruction of the airway. The rate of snoring decrease did not correlate with age, sex and BMI. Based on this study and literature review, it seems RAUP is a safe surgery, which may decrease symptoms of snoring, at least, in short-term follow-up.
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The use of local anesthesia with lidocaine containing epinephrine in patients with cardiac disease is controversial in the literature. The aim of our study was determining the safety of use the local anesthesia contain epinephrine in patients with ischemic heart disease that undergoing reconstructive surgery. Thirty two patients that had known ischemic heart disease and candidate to undergo reconstructive surgery for skin tumor enrolled in this study. All patients continued their medication for cardiac disease till morning of the operation. 10 ml lidocaine 2% containing 1:100,000 epinephrine was injected in patients for local anesthesia. The hemodynamic changes and electrocardiographic variables before injection were compared with them after injection, during surgery and till 6 hours postoperation period. A 12 lead electrocardiogram was recorded in all our cases for detection of myocardial ischemic changes. The mean age, weight and height were 58.2±10.4, 74.8.±14.4 kg and 164.5± 8 cm respectively. Twelve patients (37.5%) were diagnosed with systemic hypertension and 10 patients with diabetes (31.2%). The comparison of change of systolic, diastolic and mean blood pressure between baseline, during procedure and after operation defined that our subjects did not have any significant disturbance in blood pressure in perioperative period. The comparison of baseline heart rate with heart rate after injection, during procedure and in postoperation period indicated a significant changes in this variable (P=0.044). The heart rhythm during the perioperative period also failed to exhibit alterations. The ischemic change was not recorded in our patients before injection compared to after injection. None of our patients have any early complications because of infiltration of local anesthetic containing epinephrine in our patients. The use of 10 ml 2% lidocaine with epinephrine 1:100,000 in patients with cardiac disease represent a safe anesthetic procedure. These patients experienced a more profound anesthesia with hemodynamic stability and without myocardial ischemic changes.
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Over the past three decades physicians have used light level laser therapy (LLLT) for the management and the treatment of diabetic peripheral neuropathy and have obtained results that calls for further investigations. This study aimed to investigate the effectiveness of LLLT in treatment of pain symptoms in patients with diabetic polyneuropathy. In this study 60 patients with diabetic peripheral neuropathy were matched based on their sex, age, BMI, type of diabetes, duration of diabetes, and duration of pain, and randomized to case and control groups based on their established scores on the visual analog scale (VAS) and the Toronto clinical scoring system (TCSS). Cases received laser therapy with wavelength of 78 nm and 2.5 j/cm2 two times a week, each time for 5 min, for one month. During the same period, controls received sham laser therapy. Comparing the differences between the two groups' VAS and TCSS mean scores before the intervention with that of the 2 weeks and 4 weeks after the intervention we were able to see a statistically significant difference between the two groups (P<0.05). On the other hand, when we compared their VAS and TCSS mean scores 4 weeks and 2 weeks after the intervention we did not find any statistically significant difference between the two groups. We achieved the same results when we examined cases' and controls' pre and post VAS and TCSS scores independent from each other; no improvement in the assessment based on their 2 and 4 weeks comparisons tests. Laser therapy resulted in improved neuropathy outcomes in diabetic patients who received it relative to the group that received sham therapy, evaluating before and after LLLT assessments. Further studies are needed to test types of lasers, as well as different dosage and exposure levels required in different phase of neuropathic care, so as to obtain reproducible results.
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The issue of medical errors is currently a global concern which places a heavy financial and emotional burden on communities. A clinical decision support system (CDSS) is an electronic system designed to support clinical decision making. Considering the increasing importance and use of Systematized Nomenclature of Medicine-Clinical Terms (SNOMED-CT), we developed SNOMED-CT to implement it more efficiently in making smart history taking, decisions to perform lab tests and imaging, diagnosis and recommendations. To evaluate these capabilities in real clinical problems, a new CDSS was compiled, aimed at supporting decisions on patients with a chief complaint of low back pain (LBP). A number of LBP differential diagnoses as well as some recommended indications and contraindications published by guidelines, were inputted to the database. Future software based on this model would help physicians to do necessary assessments and recommendations and might improve patients' safety.
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Preterm birth means the birth before thirty seven week of pregnancy that causes a lot of complications for the baby. Variety factors are suggested to be involved in disease. In this study, we decided to evaluate haptoglobin (Hp) phenotypes association with clinical features of patients suffered from premature delivery to understand better the possible correlation of genetic and clinical features in this disease. This cross sectional analytic descriptive study has been carried out in two groups of 120 women, 60 with preterm and 60 with term labor. Patients were selected with previously diagnosed by a gynecologist with preterm birth in hospital during the study period. After performing diagnostic tests, the frequency of each haptoglobin phenotype in the two groups was analyzed using the X2 test and SPSS software. The maximum serum haptoglobin phenotype frequency in patients with Hp2-2, was 43 (71.7%) whereas in healthy individuals, 35 (58.3%). No statistically significant differences between the two groups was found (P=0.310). But based on some patients clinical features such as their history of preterm delivery, previous history of recurrent abortions and history of preterm delivery in their family, significant association was found with Hp2-2 compared with healthy control (P<0.003). This study showed that Hp2-2 phenotypes levels in the case group was higher than in control but the factors influencing the presence or absence of preterm labor is clinically various.
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This study focused on triple-negative breast cancer (TNBC) that is characterized by the lack of expression of estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER-2). The primary goal of this study was to describe the relation between triple-negative receptor status and survival. This is the first study about triple-negative breast cancer in our community of the 1541 patients diagnosed with breast cancer between 2002 and 2007 at the Cancer Institute (Tehran, Iran). 107 patients were identified as TNBC and 107 patients were randomly selected as non-TNB. HER-2, ER and PR status were assessed by immunohistochemistry (IHC). Analyses of their collected data were performed retrospectively and then clinical and pathologic parameters were compared between two groups. In multivariate analysis, a significantly decreased overall survival was observed for patients with TNBC compared with non-TNBC (55.7 months versus 60.7 mounts; 95%CI: 51.1-60.3 and 57.9-63.5 for TNBC and non-TNBC respectively, P=0.0008). The 2- and 5-year estimates for overall survival were 69.8% and 62.3% for TNBC, and 90% and 83% for non-TNBC, respectively. During the study period, 36 (33.6%) patient of TNBC and 14 (13.1%) of non-TNBC presented local recurrence. Significantly decreased disease-free survival was also observed for patients with TNBC compared with non-TNBC (P=0.0004). The 2- and 5-year estimates for disease-free survival were 68% and 63% for TNBC; and 89% and 82% for non-TNBC, respectively. Significantly decreased distant metastasis free survival was also observed for patients with TNBC compared with non-TNBC (54.4 mounts versus 61.7 mounts; 95%CI: 49.8-59.0 and 59.1-64.4 for TNBC and non-TNBC respectively, P=0.0004). Triple negative breast cancer has a biologic aggressive behavior and poor prognosis. Therefore aggressive treatment and regular follow-up in early stage of diagnosis can be a significant impact on their prognosis.
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To achieve tight glycemic control in diabetic patients, it may be necessary to introduce insulin therapy much earlier in the disease course. Poor glycemic control is a risk factor for the development of diabetic complications. Many patients require insulin therapy after several years of disease in order to maintain good glycemic control and prevent complications. But many patients do not receive insulin therapy in a timely manner because of a negative appraisal of this treatment. Understanding the cause of this negative attitudes is necessary for better evaluation to overcome for this problem. The purpose of this study was to evaluate the reasons for insulin refusal among patients with type 2 diabetes. This is a descriptive cross-sectional study from Yazd Diabetes Research Center. 400 patients with type 2 diabetes who had an HbA1c ≥8.0% despite optimal oral therapy were identified that participated in this study. Data were obtained by patient interview using validated questionnaires. This study showed that Insulin refusal was common. 77% of participant reported being unwilling to take insulin if prescribed. Fear of injection is an important cause for insulin refusal among patients. Insulin refusal is an important problem among our patients with type 2 diabetes mellitus. Findings of this study suggest that interventions aimed at increasing insulin use should focus on injection-related concerns, education and correction of misconceptions.
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We present 16 years old girl with primary breast lymphoma involving the both breasts simultaneously and co-incidence of central nervous system (CNS) involvement which originated from the breast, in addition to evidence of lymphoma in multi-organ such as skin, mediastinum and some abdominal viscera. Bilaterality has been observed in some series, but reports are few and series are often very small. Radiologic features may be indistinguishable from those of the other breast malignancies, but it can be concluded that primary involvement of the breast with lymphoma should be considered when breast mass or inflammatory changes occur in a patient without any previously diagnosed lymphoma. The clinical behavior, imaging and therapeutic procedures are discussed. The findings of this report may have clinical impact on oncologists or that may alter the disease concept of bilateral breast lymphoma.
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An 80-year-old diabetic man with severe aortic stenosis was admitted to our hospital for cardiogenic shock complicating non-ST-elevation myocardial infarction. Echocardiographic evaluation showed also a severe degree of both left ventricular dysfunction and mitral regurgitation. The patient was initially stabilized with inotropes and mechanical ventilation was necessary because of concurrent pulmonary edema. The day after, he was submitted to coronary angiography showing bivessel coronary disease. Given the high estimated operative risk, the patient was treated with angioplasty and bare metal stent implantation on both right coronary and circumflex artery; contemporarily, balloon aortic valvuloplasty (BAV) was performed with anterograde technique, obtaining a significant increase in planimetric valve area and reduction in transvalvular peak gradient. Few days after the procedure echocardiogram showed an increase in left ventricular ejection fraction, moderate aortic stenosis with mild regurgitation and moderate mitral regurgitation. Hemodynamic and clinical stabilization were also obtained, allowing amine support discontinuation and weaning from mechanical ventilation. At three months follow-up, the patient reported a further clinical improvement from discharge, and echocardiographic evaluation showed moderate aortic stenosis and an additional increase in left ventricular function and decrease in mitral regurgitation degree. In conclusion, combined BAV and coronary angioplasty were associated in our patient with hemodynamic and clinical stabilization as well as with a significant reduction in transvalvular aortic gradient and mitral regurgitation and an increase in left ventricular ejection fraction both in-hospital and at three month follow-up; this case suggests that these procedures are feasible even in hemodynamically unstable patients and are associated with a significant improvement in quality of life.
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Intra-abdominal desmoplastic small round cell tumor is a rare entity with a few reports worldwide. This tumor commonly occurs in children and adolescent and occurrence in adult age group is very rare. Here, we describe an adult male with symptoms of intestinal obstruction due to abdominal mass, located in splenic flexure. After resection, the diagnosis of intra-abdominal desmoplastic small round cell tumor was established by pathologic and immunohistochemical studies. We emphasize that albeit being rare, this tumor should be mentioned as one of the differential diagnoses of widespread intra-abdominal lesions in any age group. A brief review of epidemiology, clinical manifestations as well as pathological and molecular features is also included in the paper.
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Disseminated tuberculosis (TB) is commonly seen in HIV-infected patients and is major cause of death in these patients. In HIV-infected patients disseminated tuberculosis is frequently undiagnosed or misdiagnosed. In this article we report a case of disseminated TB in a HIV-infected patient with a relatively long history of fever and other complaints without definite diagnosis. Diagnosis of disseminated TB was confirmed by bone marrow biopsy and polymerase chain reaction analysis (PCR) of the ascitic fluid. With anti-TB treatment signs and symptoms improved.
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