Vol 56, No 11 (2018)

Published: 2018-11-29


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    Screening of cervical cancer is the most common gynecologic cancer in developing countries. Despite being preventable, but we have still some problems with the screening of this cancer. Recently, many studies have been done on immunohistochemistry to improve screening of cervical intraepithelial neoplasia (CIN) as a precancerous lesion. But, the majority of the studies are based on cytological samples. The objective of this study was to analyze the correlation KI-67 biomarker and HPV infection in predict short time prognosis in CIN as an alternative or auxiliary method to the current screening method in a different geographic population. This descriptive cohort prospective study included 40 patients with a diagnosis of CIN based on cervical punch biopsy samples after colposcopy examination. They were referred to the department of gynecology and oncology of an academic hospital, Mashhad University of   2016 to 2017. All samples were investigated for HR- HPV DNA with Cobas test and immunostaining for KI-67 biomarker. Finally, after one year follows up, the prognosis for all patients was evaluated. Data were analyzed by SPSS software program version 23.0 and Mann-Whitney U test and Fisher's exact test. P<0.05 was considered significant. Significant difference was found between HR-HPV positive and negative tests in KI-67 expression (P<0.001), but no significant difference was observed in reactivity level (P=0.5), also no significant difference was found in KI-67 expression in the metaplastic and non-metaplastic epithelium (P=0.88). KI-67 biomarker is recommended as complementary screening tests not alternative for differentiating in high risks patients with CIN1. The patients with low KI-67 / HR-HPV positive test could be offered for a less aggressive follow-up protocol.

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    Breast cancer is the most common malignancy of females. Breast cancer is a heterogenic disease; it consists of several subtypes based on the expression of different genes. Risk factors associated with each subtype is not completely understood, yet. Moreover, recognizing the cancer subtypes may alter the treatment plan. The aim of this study was to evaluate different breast cancer subtypes in women more than 65-year-old. This was a cross-sectional study done on patients with breast cancer aged 65 years and older presenting to clinics of Emam Reza and Omid Hospitals, Mashhad, Iran between 2005 and 2015. Statistical analysis was carried out using SPSS ver. 16. P<0.05 was considered statistically significant.A total of 225 breast cancer patients age 65 and older were included in our study. When we categorized our patients by breast cancer subtypes, 69.8% had the Luminal A, B subtype, 23.1% had Triple-Negative subtype, and the remaining 7.1% had HER-2 enriched subtype.Different breast cancer subtypes in patients aged 65-year-old and higher were Luminal A, B, HER-2 enriched and Triple-negative, respectively. We also showed that patients with Luminal A, B subtypes had significantly higher BMI and BSA compared to other subtypes.

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    The aim of this study was to evaluate the association between depression and chronic complications, in clients with traumatic spinal cord injury (TSCI). Eight hundred and thirty Traumatic Spinal Cord Injury (TSCI) patients were enrolled in this study. All cases filled up the Valid and Reliable Persian version of the Beck Depression Inventory (BDI). Each patient was examined by a constant neurosurgeon, and a TSCI research fellow to determine the level of injury, AIS (ASIA impairment scale) grade, and chronic complications. Eight hundred and thirty individuals participated in the study. Mean Spinal Cord Independence Measure (SCIM) score was 57.5±20 in cases with BDI<10, while it was 57.2±15.6 in patients with 9<BDI<19, 55.5±16.3 in cases with 19≤BDI<30 and 52.3±14.9 in cases with BDI≥30 (P=0.02). Also, the prevalence of pressure ulcers, neuropathic pain, spasm, suicide attempts, and sexual dysfunction were significantly higher among cases with major depression (BDI≥30). Mean visual analogue scale (VAS) was significantly higher and mean SCIM was significantly lower in patients with BDI≥30. There was a significant negative correlation between SCIM and BDI scores (r=-0.5, P=0.004) and significant positive correlation between VAS and BDI (r=0.65, P=0.04). Depression is an important risk factor in patients with TSCI for development of secondary complications. Chronic complications and greater functional dependency were observed more frequently in cases with BDI≥10.

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    Recently, there have been a few reports of an outbreak of lead poisoning due to opium contaminated with lead in Iran. This study aimed to evaluate the clinical features of lead toxicity in opium abusers, and response to oral chelation therapy based on the severity of poisoning. One hundred thirty-three chronic opium users with a diagnosis of lead poisoning were included. Based on blood lead level (BLL), the cases were divided into 2 mild (BLL;40-69 µg/dL) and moderate (BLL;70-100) groups. Both groups received D-penicillamine (D-P) as a Chelator. Changes in BLL compared between two groups. All cases were oral opium users. Abdominal pain (75%), anorexia (55.6%), and constipation (53.2%) were the most common symptoms of lead poisoning.  67.8% of cases experienced only one round of chelation therapy and "Rebound phenomenon" happened in 9% of these. Ninety percent of the patients had wellbeing sensation, and symptoms improved at the end of the first round of treatment. The mean BLL before and after chelation therapy were 66.87 and 45.7 µg/dL, respectively. Oral Chelator reduced BLL in both mild and moderate poisoning groups (35.61% vs. 35.90%, P: 0.057), respectively. The comparison of BLL before and after chelation therapy showed that the treatment was effective equally in both mild and moderate toxicity. However, in a few cases, the rebound phenomenon may occur.

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    The purpose of this study was to evaluate the self-care assessment questionnaire that is used to study the level of self-care in healthy adults. In the first stage, the self-care assessment questionnaire was translated from English to Persian using the forward-backward method. The final Persian version was evaluated in terms of translation clarity, compliance with Iranian culture, and consistency with concepts in the original version. Subsequently, the psychometric properties of the tool were determined. During the translation and localization process, changes were made to the Persian version for a better understanding. The Cronbach’s alpha coefficient of the different dimensions of the tool was within the desired range (0.782-0.924). Considering the importance and necessity of a self-care assessment questionnaire in healthy adults, a comprehensive and multidimensional questionnaire was selected and localized. This questionnaire can be used to improve the level of health and self-care.

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    Clonidine, the α2-adrenergic agonist, is usually used as an antihypertensive drug. Dextromethorphan is a non-competitive NMDA antagonist which is routinely prescribed to suppress cough. However, there are not confidential documents regarding their analgesic effects. Due to the controversies over the analgesic properties of these two drugs, this study was designed to evaluate cold pain threshold changes following their administration. This study was conducted to assess the impact of oral clonidine and dextromethorphan on ice-water immersion tolerance. Four closed sachets labeled with codes were dedicated to each participant. Each of these four sachets contained placebo, 0.3 mg/kg dextromethorphan, 0.2 mg clonidine or both of the previous drugs randomly. The cold pain threshold was measured five times for each participant, once before taking any drug (T1) and the next four times (T2-T5) after taking each of the four sachets. 35 volunteers (15 men and 20 women) participated in the study. The study showed that cold pain threshold was higher in men than women (P=0.004) and also in participants above 30 than those under 30-year-old (P=0.007). Moreover, the pain threshold did not change significantly after the administration of clonidine (P=0.33) or dextromethorphan (P=0.21), but the threshold significantly increased after receiving a combination of dextromethorphan and clonidine compared with placebo overall (P=0.001). Cold pain threshold was higher in men and individuals over than 30-year-old and decreased significantly after administration of clonidine and dextromethorphan conjointly. Body mass index has no relation with changes in cold pain threshold by taking mentioned medications.

Case Report(s)

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    Histiocytic sarcoma is a rare hematopoietic malignancy that originates from histiocytes, and may involve lymph nodes and extranodal sites such as the spleen, head and neck, skeleton, liver, breast, bone marrow, mediastinum, pancreas, skin, lung, kidney, central nervous system, testis, gastrointestinal tract, and uterus. The involvement of the nasal cavity is considered extremely rare. The prognosis is poor, even with chemotherapy, and the survival time is usually two years. We report the case of a 16-year-old-male with primary histiocytic sarcoma of the nasal cavity. The diagnosis was based on classical histopathology and immunohistochemical findings. This malignancy has not shown consistent satisfactory responses to chemotherapy regimens.

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    A 65-year-old woman with hypothyroidism and arterial hypertension was admitted with epigastric pain and hyperemesis. Five months before, she had the diagnosis of non-lithiasic acute pancreatitis without complications, and the hypothesized etiology was alcohol abuse. The current manifestations were initially related to an active gastric ulcer evidenced by the endoscopic study. Laboratory data were consistent with acute pancreatitis, and ultrasonography showed images of pancreatitis, in addition to the incidental detection of the hydropic gallbladder with a Phrygian cap. These diagnoses were confirmed by the imaging study of computed tomography with contrast. Clinical significance of Phrygian cap anomaly is herein emphasized because of diagnostic challenges, in addition to possible etiopathogenic role in cholecystitis, gallstones, and pancreatitis. The eventual association of the gallbladder anomaly with the Saint’s triad is also commented. This scarcely reported triad includes hiatus hernia, diverticulosis, and lithiasic cholecystopathy.


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    Actinomycosis is a chronic granulomatous bacterial disease. It has a tendency to spread contagiously and suppurate forming granulation tissue, and multiple abscesses, which drain through skin forming sinus tracts. Sulphur granules discharging through sinus tracts are the characteristic features. Its varied presentation is always confused with malignancy rather than an infective process. We report an extraordinary case of recurrent abdominal wall actinomycosis spreading to the liver, right kidney, intestine,and pelvic organs because of discontinued treatment with penicillin. We emphasize the importance of long-term antibiotic treatment, which if deferred can lead to recurrence of the disease which could be life threatening at times.

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    Serous cystic neoplasms of the pancreas account for 10% to 16% of all pancreatic cystic masses. Serous cystic neoplasms were evaluated as benign pancreatic masses. For all that, the first serous cystic neoplasm with malignancy criteria was described by George in 1989. Only 10 cases have been observed until today. A 53-year-old female patient presented with complaints of jaundice and abdominal pain. Her past medical history revealed pancreatic cysts during the examination for abdominal pain. Computed tomography revealed a cystic mass of approximately 8 cm in size with a solid component originating from the head of the pancreas and leading to obstruction in the bile duct. She underwent pylorus-preserving pancreaticoduodenectomy and was discharged on Day 12 due to the absence of any surgical abnormality during the postoperative follow-up. On examination of the surgical specimens, a multiloculated cystic tumor with a serous content was detected. Tumor metastasis which demonstrated a positive reaction with cytokeratin 7 and cytokeratin 19 in the celiac lymph node biopsies was detected. The tumor was found to have a histomorphologically benign appearance and was reported as a serous cystadenocarcinoma based on the desmoplastic stroma and lymph node metastasis. Cystic neoplasms of the pancreas can be followed conservatively. Malignant transformation in pancreatic serous cystadenocarcinoma should be kept in minds such as pancreatitis, bile duct obstruction, and new-onset or increased complaints during follow-up.