A. R. Dehpour, PharmD, PhD
A. Javadian, MD
Vol 51, No 2 (2013)
Breast carcinoma is the major cause of cancer-related death in women. The incidence of this carcinoma is rising and there are many attempts to decrease this problem. The aim of this study was detection of full-length cytokeratin 19 (CK19) mRNA, in peripheral blood and tissue of breast cancer patients in early stage of cancer. In this study, RT-PCR (reverse transcriptase-polymerase chain reaction) technique was used for detection of CK19 mRNA in peripheral blood and tissue of breast cancer patients. Primers were established to amplify the CK19 as a tumor marker. Moreover, CYFRA 21-1 subunit of CK19 protein was measured in the serum of patients. CK19 mRNA was detected and sequenced. It is shown that the most released CK19 mRNAs in blood and tissue of cancer patients are non-coding RNA. The mutated forms of mRNA are the incomplete transcripts of protein-coding gene as a long non-coding RNA (lncRNA) that could regulate gene expression. Moreover, small non-coding RNA (ncRNA) as fragments of CK19 is mostly observed in this experiment. They may play a role in tumorogenesis and their biologic exact function in breast cancer should be further elucidated.
Heparin has an unpredictable pharmacokinetics and the responses of individuals may vary distinctly. Therefore, different dosing nomograms have been proposed. The aim of this study was to compare two prevalent nomograms to adjust heparin doses in hospitalized patients with acute coronary syndrome. One hundred and forty patients received heparin infusions based on one of two nomograms. Group 1 received a bolus of 80 U/Kg/h and an initial infusion rate of 17 U/Kg/h. In the second group, a bolus of 60 U/Kg (maximum of 4000 U) and an initial infusion rate of 12 U/Kg/h (maximum of 900U/h) was given. Activated partial thromboplastin time (aPTT) was measured at the beginning and every 6 h for 48 hours. The rate of heparin was changed according to each nomogram in order to maintain aPTT in the therapeutic level of 46-70 s. The time to pass threshold was on average 7.63±3.95 h for nomogram 1 and 11.05±4.41 h for the second nomogram (P<0.001). At 48 hours, the proportion of patients in the therapeutic range in group 1 was higher (72.86% vs 45.71%). The time patients stayed at the desired levels was significantly higher in nomogram 1 and they also required fewer heparin rate adjustments (3.41±1.55 vs 4.53±1.63). This study indicated that using nomogram 1 facilitated a more rapid achievement of the therapeutic threshold, higher proportion of patients in the therapeutic range for a longer time, and fewer changes of in the heparin rate.
This study was aimed to investigate the use of panoramic radiography in patients with low bone mineral density (BMD) in order to diagnose and prevent osteoporotic fractures. Panoramic radiographs of 60 patients (20 men and 40 women) aged from 40 to 70 years with cortical thicknesses of less than 3 mm in the mandibular angle were selected from patients referred to a dentomaxillofacial radiology clinic and were then examined for mandibular cortical angles. These were measured using Computed Radiography (CR) software. The bone densitometry was carried out using Dual Energy X-ray Absorptiometry (DEXA). Cortical thicknesses at the lower border of the mandibles were also measured by panoramic radiographs. Statistics analyses were then undertaken using Fisher's exact test, Chi-square, t-test, ANOVA and receiver operating characteristic (ROC) curve. In most cases, no significant difference in mandibular angle cortical thickness was found between those patients with a normal BMD and those patients with a lowered BMD (P=0.621). There was a relationship between the cortical thicknesses of the mandibular lower border, and vertebral and femoral BMD (P<0.0001), and there was a significant difference between the thickness of the mandibular lower border and BMD. The results of this study also revealed a new marker of osteoporosis on the mandibular lower border under the third molar. A thickness of 2.80 mm of the mandibular lower border was detected as a threshold for the measurement of bone densitometry in the chosen Iranian population. Panoramic radiography is effective for screening patients who are at risk of having decreased bone mineral density. Patients with a threshold of 2.80 mm thickness of the mandibular lower border should be considered as individuals likely to have osteoporosis associated low bone density.
In light of provided progresses in ultrasound measurements of lateral abdominal muscles, an important role for these muscles, particularly transverse abdominis (TrA) muscle in stability of the spine has been suggested. Some authors have found significant correlations between body mass index (BMI) and thickness of these muscles. The aim of this study was to examine possible association between different methods of measurements of fatness and lateral abdominal muscles thicknesses, employing ultrasound imaging in healthy subjects. Ninety healthy male volunteers aged 18 to 38 (mean= 31.37, standard deviation=5.09) who met our inclusion criteria participated in this study. BMI, skin fold thickness, weight and waist circumference were assumed as the major outcomes for measurement of fatness of the subjects. Employing ultrasound measurements, the thickness of TrA, internal oblique (Int Obl) and external oblique (Ext Obl) muscles were also measured. We found positive significant relation between Ext Obl muscle thickness and all methods of measurements of fatness. Reversely, the results show that Int Obl muscle thickness significantly decreases with the rise of all methods of fatness measurement except weight which had no significant correlation with Int Obl thickness. No significant relation between the TrA muscle thickness and different measurements of the fatness of the subjects were found. In the studies investigate the thickness of lateral abdominal muscles; the authors try to match the participants of different groups of their study regarding the BMI. We found that both waist circumference and skin fold thickness measurements might be assumed as surrogate of BMI, in aim of matching the participants on Ext Obl muscle thickness.
Diabetes mellitus type Ι is a metabolic disorder that affects multiple systems including the inner ear. Patients with diabetes mellitus commonly complain about dizziness, floating sensation, tinnitus and sweating. The aim of this study was to compare vestibular evoked myogenic potentials (VEMPs) between diabetic patients with or without neuropathy. Subjects included 14 patients with diabetes mellitus type Ι with polyneuropathy, 10 patients with diabetes mellitus type Ι without polyneuropathy and 24 healthy volunteers. Range of age in participants was 15-40 years old. The VEMPs were recorded with 500 Hz tone bursts with intensity at 95 dB. There was statistically significant difference between the groups in P13 and N23 latencies (P<0.05). There was no statistically significant difference between groups in absolute and relative amplitudes. Prolonged latencies of the VEMP suggest lesions in the retrolabyrinthine, especially in the vestibulospinal tract.
Tuberculous meningitis (TBM) and acute bacterial meningitis (ABM) cause substantial mortality and morbidity in both children and adults. Identification of poor prognostic factors at patient's admission could prepare physicians for more aggressive monitoring of patients with meningitis. The objective of this study was to determine the predictive value of neurological features to differentiate ABM and TBM. A retrospective study was conducted between patients affected with ABM or TBM admitted to three teaching hospitals during the last 14 years in Zahedan the central city of Sistan and Balouchestan province (Iran). The neurological features include seizure, level of consciousness, stroke, focal neurologic deficit and cranial nerve palsy at the time of admission. Mean age for patients with TBM and ABM were 41 ± 22.4 and 24 ± 18.5 years respectively. In univariate analysis, all measured variables revealed significant difference between ABM and TBM patients except for seizure episodes. Multivariate logistic regression analysis showed positive predictive effect of cranial nerve palsy (AOR=1.980, CI 95%: 1.161-3.376) on the diagnosis of TBM. In our study cranial nerve palsies was the most important neurological predictor factor to differentiate TBM from ABM.
Malnutrition and inflammation are the most important causes of cardiovascular disease in hemodialysis patients. This study was conducted to evaluate the effect of increase in hemodialysis frequency on C-reactive protein (CRP) level and nutritional markers in contrast to previous routine method. 18 hemodialysis patients with a mean age of 53±16 years were randomly selected in this before-and-after clinical trial. The patients under a standard hemodialysis of 3 times/4 h per week were converted to 4 times/4 h for a period of 6 weeks. The CRP, albumin, triglyceride, total cholesterol, LDL, HDL serum levels, anthropometric indices and 24-h diet recall intake was assessed before and after of the period. The data were analyzed using paired t-test, and P-value less than 0.05 was considered significant. All patients completed the study. Mean weight, body mass index and serum albumin increased while serum CRP level decreased significantly after the intervention (P<0.03). Triglyceride, total cholesterol, LDL, HDL, as well as energy, protein and fat intake had no significant change before and after the study. Increase in dialysis frequency decreased systemic inflammation and improved the nutritional state of hemodialysis patients. Therefore, it may decrease the risk of cardiovascular events in these patients.
This study was aimed to evaluate the efficacy of dipstick tests (leukocyte esterase and nitrite) in diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients. Forty six children with ascites hospitalized between 2009 and 2010 in Children Medical Center were enrolled in this study. Reagent strip assays for leukocyte esterase and nitrite were performed on ascetic fluid and the results were compared to manual cell counting and ascitic fluid culture. SBP was defined as having a polymorphonuclear ascites count of ≥ 250/mm3. Twenty children were female and twenty six were male with mean age of 3±3.9 years. The sensitivity specificity, positive and negative predictive values of the leukocyte esterase reagent strips were all 100%. The sensitivity, specificity, positive and negative predictive value of the nitrite reagent strip test were 100%, 97%, 90% and 100% respectively. Leukocyte esterase reagent strips may provide a rapid, bedside diagnostic test for the diagnosis of SBP.
This paper presents the case of a 35 year-old woman with symptoms of heart failure from the last month. A physical examination at admission showed paleness, dyspnea, peripheral edema and fatigue. In a two-dimensional echocardiography and transesophageal echocardiography, normal thickness but severe left and right ventricular dysfunction with severe pericardial effusion and thickened pericardium were found. In the enlarged right atrium, an oval-shaped structure was found with features of continuity with lateral right atrial wall and also a bulging of the structure through the orifice of the tricuspid valve to the right ventricle. In the echocardiography, we did not saw any blocking of the tricuspid valve or the inflow from inferior vena cava (IVC) or superior vena cava (SVC) or coronary sinus. On the basis of the echocardiography examination and clinical presentation, tentative diagnosis of the right atrium myxoma was made. A coronary angiography revealed normal coronary arteries and no feeding of tumor by branch of right coronary artery (RCA). Surgical removal of the tumor was performed without complication. The histopathological examination confirmed the diagnosis of angiosarcoma. In the follow-up echocardiography carried out after three months, severe left ventricular (LV) and right ventricular (RV) dysfunction continued and was demonstrated. Magnetic resonance imaging revealed no lymphadenopathy or re-growth of the tumor in the mediastinum or pericardium.
Ventriculoperitoneal (VP) shunt placement that diverts the cerebrospinal fluid (CSF) into the peritoneal cavity is the most common method of treatment of hydrocephalus. This shunt has a high incidence of malfunction mainly due to catheter obstruction or infection. About 20% of these complications are abdominal that may occur at any time after shunt placement from 1 week to several years. This study reports a case of 2.5-year old child with a history of hydrocephalus who had a VP shunt placed which was protruded from the anus on the day of referral. The patient was treated successfully after extrusion of the shunt through the anus, receiving antibiotics and being carefully observed. He was discharged from the hospital after one week.
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