Mammographic findings in different breast cancer subtypes [luminal, Her2 positive, triple negative]

Background: prognosis and management of breast cancer are defined by different variables including histological type, grading, clinical stage, Her2+, estrogen and progesterone receptor conditions. Generally, mammography is one of the most important imaging which is done in breast cancer patients. The aim of this research was to evaluate different mammographic patterns in different breast cancer sub types

Materials and Methods: demographic and clinicopathologic data of 128 breast cancer patients which referred to two academic hospitals were obtained from their registered files and their mammographies were reviewed by two radiologists separately. Patients were categorized into 3 groups of Luminal, triple negative and Her2+ and the checklists were filled out by research team. The mentioned data was then analyzed by the SPSS software version 16

Results: in this study we found significant difference in margins' clarity and axillary lymphadenopathy between mammographic presentations of different breast cancer subtypes [P=0.041] and [P=0.14], respectively; but the difference of other mamographic presentations including mass existence, mass size, margin type, peleomorphic calcification, micro calcification, nipple retraction, skin thickening and tissue distortion were not significantly different between three groups [P>0.05]

Conclusion: results of current study showed no significant difference between mammographic features of different invasive breast cancer subtypes except for axillary lymphadenopathy and ill-defined margins. Since the majority of patients were in premenopausal status, perhaps we can say lower sensitivity of mammography in premenopausal women could not accurately distinguish mammographic differences between invasive breast cancer subtypes in this study

Prognostic Factors and Treatment Outcome in Glial Brain Tumors; Data from the Third Neuro-oncology Scientific Club’s Input Forum, 2013, Mashhad, Iran.

Management of the central nervous system malignancies are among the evolving areas of research and clinical practice requiring a well-coordinated interdisciplinary approach. The neuro-oncology scientific club (NOSC) has tried to cross the links between various disciplines’ experts involved in brain tumor care in Iran since 2011. The NOSC’s structured collaborative brain tumor registry (BTCR) and the support received from its steering committee and provincial boards have been the key elements for its success and growth so far. This scientific community not only has helped to optimize brain tumor care but provided interdisciplinary research opportunities to its members across Iran. Mashhad’s NOSC has been the pioneer in the above. During the 3rd Mashhad’s NOSC meeting held in November 21st 2013, the interim results from some important local neuro-oncology studies were presented. Some potential opportunities to improve the coordinated interdisciplinary brain tumor care within the province were discussed by neurosurgery, neuroradiology and radiation oncology faculty at this provincial NOSC meeting. Clinical outcome, survival data and prognostic factors in adult and pediatric gliomas over the past several years in Mashhad, the association between methyl guanine methyl transferase (MGMT) methylation status (determined by MSQP or methylation specific quantitative polymerase chain reaction) where among the main studies outlined during this event. We realize that optimized brain tumor management and productive research in neuro-oncology can only be achieved through an integrated approach and strong team work. This is what the NOSC pursues.

[Re-conceptualization of customer results criterion of organizational excellence model for the health care sector in the Iranian national productivity and excellence award]

Introduction: The literature and the experiences of different countries, introduces the implementation of organizational excellence models in health care sector as a way to achieve a developed health care system. This study focused on the process of re-conceptualization of Customer Results criterion in organizational excellence model

Methods: The first edition of the criterion was designed through library studies and synthesizing method. Then, two questionnaires were designed and Delphi Method was used to collect experts' ideas on the criterion. Cronbach's Alpha was used to test the reliability of the questionnaires. Content Validity was also used to test its validity. The second edition of Customer Results criterion was prepared using Focus Groups and in the third stage, the second edition was reviewed in National Productivity and Excellence Award committee. For the fourth stage the criterion was uploaded to the website of Award then the health and treatment committee of award, as well as the managers and experts in the field of organization excellence and award assessors were asked to give their opinions on the criterion which was then revised according to the collected opinions. In the final stage, the model was implemented in 23 hospitals to test its validity and then necessary modifications were applied

Results: There are more than 200 points for a better understanding of general organizational excellence model in health and treatment sector. They are categorized into two groups: 156 guide points for sub criterion of organizational excellence model and 95 complementary points which are supplement guide points

Conclusion: The re-conceptualization process of Customer Results criterion in the European Foundation for Quality Management Excellence Model for the Health Care Sector covers different aspects of the criterion. Therefore, it can be used by many users and when implemented can help them achieve the most developed health care system

Study of lymphedema risk factors among patients with invasive breast cancer after the initial treatment

Introduction: Upper limbs lymphedema is one of the rather common and debilitating sequels of breast cancer treatment. The incidence of this sequel has been reported in different sources to be from 25% to 38%. The purpose of this study was to evaluate the incidence and the risk factors of lymphedema following invasive breast carcinoma treatment

Materials and Methods: Recorded data of breast cancer patients referred to Mashhad Omid Hospital between 1997 and 2005 were evaluated for the incidence and risk factors of lymphedema. Univariate and multivariate analysis were performed to evaluate the risk factors using a logistic regression model

Results: Out of 312 patients entering the study 101 patients [32.4%, 95% CI: 27.2-37.6] developed lymphedema. Univariate analysis did not show a statistically significant difference between the rates of lymphedema in radical mastectomy when compared to other types of surgery such as lumpectomy with axillary dissection. Obesity according to body mass index significantly affected the development of lymphedema [p=0.03]. The average number of metastatic nodes was 4.56 +/- 4.05 in patients who had and 2.48 +/- 3.19 in patients who did not have lymphedema [p<0.01]. The average percentage of metastatic to excised nodes was%54.59 +/- 37.48 in patients who had and%34.67 +/- 34.84 in patients who did not have lymphedema [p<0.01]. Age, the number of excised nodes, the stage of disease, hormonal therapy, adjuvant radiation therapy and chemotherapy had no correlations with lymphedema

Conclusion: According to our findings, body mass index, the number of metastatic nodes and the percentage of metastatic to excised nodes were correlated with the development of lymphedema

[Evaluation of a correlation between the time of low dose fentanyl injection and hemodynamic responses during tracheal intubation]

This clinical trial was conducted to evaluate optimal time of injection of a small dose of fentanyl during anesthetic induction to attenuate circulatory responses to laryngoscopy and tracheal intubation. 120 patients who had enrolled in this clinical trial, with ASA physical status of I or II scheduled for the elective surgery. The patients were randomly allocated to five groups. In groups II, III, IV, and V, patients received fentanyl [2 mcg/kg] 1, 3, 5, or 10 min respectively before tracheal intubation. In group I patients did not receive fentanyl and served as the control group. After induction with thiopental and atracorium, an oral tracheal intubation was accomplished in each patient. Changes in each circulatory variable after tracheal intubation were based on the differences between baseline values and values obtained 1 min after intubation. Increase in postintubation heart rate, diastolic and mean arterial pressure compared with preinduction values in group III was less than the other groups. Increased systolic pressure in group IV was less compared with other groups; but there was not a significant difference between groups III and IV. The results of our study revealed that the optimal injection time of fentanyl in blunting the circulatory responses to tracheal intubation is 3 min before intubation

[Tabriz general dental practitioners' knowledge and attitude evaluation on space maintainer]

Space maintainers are appliances used to preserve the space and prevent ectopic movement of adjacent and opposing teeth when premature loss of deciduous teeth occurs. This study aimed at evaluation of general dental practitioners' knowledge and attitudes regarding the space maintainers in Tabriz. This descriptive cross-sectional study involved 151 subjects, selected randomly from 450 general dentist practicing in Tabriz city/province, located in the North-West of Iran. A self-administered questionnaire was provided to subjects and included questions to evaluate the knowledge and attitudes as well as their case selection policy. Data were analyzed using Chi-square and ANOVA tests. 103[70%] of dentists were male. The mean age of subjects was 33.32 years. The mean score on knowledge was 5.32 out of 10 and the mean score on attitude was 25.3 out of 40. About 76.5% [n=115] of participating dentists admitted child patients, younger than 12 years old. These dentists had higher scores in both sections than others. This difference wasn't significant. Increasing scores in the years after graduation was followed by decreasing scores which was statistically significant [P<0.05]. The general dental practitioners under investigation in this study had a good attitude towards the use of space maintainers. Their knowledge in this regard, however, could be improved by means of attending continuing dental education programs, workshops, brochures and pamphlets

Comparision of barry and barry-taguchi ureterovesical reimplantation techniques in kidney transplantations: a randomized clinical trial

Renal transplantation is the treatment of choice for chronic renal failure. Using a suitable uretero- vesical anastomosis technique can prevent most of risks for kidney graft. Extravesical ureteroneocystos- tomy is becoming popular in renal transplantation because of the low complication rate and technical ease. The decreased complication rate is due to limited bladder dissection and the need for a shorter ureteral segment from the donor. In this study we assessed the effectiveness and complications of a new technique, Barry-Taguchi technique and compared it with Barry technique. We recorded all urological complications developed in the recipient's kidney between September 2004 and March 2007 [mean follow-up 12 months] after performing extravesical Barry-Taguchi [new tech- nique] and Barry ureteroneocystostomy. The urological complications studied included complicated hema- turia, urinary fistula, and ureteral stenosis. A total 100 patients who underwent Barry-Taguchi technique and 98 patients who underwent Barry technique were studied. The incidence of urological complications in Barry-Taguchi and Barry re-implan- tation technique was 4% [n=4] and 5% [n=5%], respectively. These complications included 1 urinary leak- age and 3 ureteral obstructions for Barry-Taguchi technique, and 4 obstructions and 1 leakage from Barry group. In both trial groups, no complicated hematuria has occurred. In addition, the recorded time taken for ureteral anastomosis ranged from 4 to 16 [mean 8.3] min for Barry-Taguchi technique and 5 to 20 [mean 9.9] min in Barry technique. The Barry-Taguchi extravesical ureteroneocystostomy technique is a rapid and rather simple tech- nique. Without increasing the incidence of urological complication rate, it is a reliable method for perform- ing ureteroneocystostomy

Risk factors and laboratory diagnostics for post renal transplant tuberculosis: a case-controlled, country-wide study on definitive cases

Tuberculosis [TB] is a common cause of morbidity and mortality in renal transplant recipients. It is usually misdiagnosed because of lack of medical awareness and its infrequency in renal transplant recipients. 44 cases [0.3%] with post-transplant TB out of 12820 patients who had renal transplants performed between 1984 to 2003 were found from the hospital records of 12 major kidney transplantation centers in Iran. These cases were compared with 184 healthy transplant subjects whose transplants were performed by the same surgical team as the controls. The mean age of cases and controls was 37.7 [13-63] and 35.6 [8-67] years [p=0.3], respectively. The mean duration of pre-transplantation hemodialysis was 30.3 [3-168] months in cases and 18.2[1-180] months in controls [p=0.03]. A past history of tuberculosis was detected in 2 cases and 1 control [p=0.3]. The mean doses of initial and maintenance immunosuppressive drugs in cases and controls were not significantly different. A total of 25 cases [56.8%] and 60[32.6%] controls had rejection prior to diagnosis of TB [p=0.004; OR=2.7, CI95%: 1. 3-5.6]. To our knowledge, this is the first study that demonstrated increasing risk of post-transplant TB by extending the duration of pre-transplant hemodialysis and the number of post-transplant rejection episodes. Further study is needed to clarify our new findings specifically in respect of different immunosuppressive regimens

Complications after dipyridamole infusion in myocardial perfusion SPECT and correlation with homodynamic changes

In Iran dipyridamole is the main agent used for coronary dilatation before myocardial perfusion SPECT. This study tries to evaluate the side effects after dipyridamole infusion and its relation with hemodynamic changes. We studied 300 patients who referred to myocardial perfusion scan. The exclusion criteria were: 1] AV block degree 2 or more, 2] Asthma 3] Sick sinus syndrome 4] LV EF<25%. Dipyridamole infusion was done with a dose of 0.568 mg/kg of body weight for 4 minutes and blood pressure and pulse rate were measured before infusion of dipyridamole and 2 minutes after termination of infusion. Patients were asked for any side effects and any complaints were recorded. Relationship between these side effects and age and sex of patients as well as hemodynamic changes were studied. 148 female and 152 male patients studied with a mean age of 55.9 years [11.1]. After dipyridamole infusion 79.3% of patients had at least one symptom, with headache [50%] and sweating [3%], the most and the least prevalent symptoms respectively. Mean heart rate increment was 8.8 and 9.2 beat per minute in female and male respectively [P=0.59]. Mean systolic blood pressure decrement was 8.5 [8.6] and 9.6 [7.1] mmHg in male and female respectively [P=0.21]. Diastolic pressure decrement was 4.6 [6.7] and 6.8 [6.3] mmHg in male and female respectively [P=0.003]. Headache and flashing were more frequent in female patients [P=0.004]. Other symptoms like dizziness, dyspnea, chest discomfort and abdominal discomfort were not different between female and male patients [P>0.08]. After dipyridamole infusion, nonspecific side effects are frequent. Headache and flashing is more frequent in female patients. Flashing is related to decrement in diastolic blood pressure

Prevalence of cryptosporidium spp. infection in renal transplant and hemodalysis patients

Transplanted and hemodialysis patients are frequently affected by parasitic diseases such as cryptosporidiosis. Cryptosporidium is a parasite causing self-limited diarrhea and enteritis in healthy individuals. The presence of Cryptosporidium infection was studied in three groups including 87 renal transplant patients, 103 hemodialysis patients, and 60 healthy individuals as the control group. Two stool specimens were obtained from each case. The specimens were concentrated by the formalin-ether method and two smears were prepared from each. The smears were stained by modified acid-fast method and were observed under a light microscope. Ten [11.5%] renal transplant and 4 [3.88%] hemodialysis patients were positive for Cryptosporidium infection. No positive results were obtained in the control group. The results showed a statistically significant difference between renal transplant and control groups [P= 0.02], but the difference between hemodialysis and control groups was not significant [P= 0.2]. The results also showed that the rate of Cryptosporidium infection in renal transplant patients was much higher than hemodialysis patients. The susceptibility of renal transplant patients to Cryptosporidium infection is much more than other studied groups and this could be due to immunosuppressive therapy in these patients

Evaluation of urinary calculi by infrared spectroscopy

To analyze urinary calculi composition and its relationship with gender, age, calculus weight, color, and location. Two hundred and forty one patients with urinary calculus, who had undergone open lithotomy from June 1999 to April 2001, were enrolled in this prospective study which was performed by Tehran and Oroomieh Medical Sciences Universities. The calculi compositions were analyzed by infrared spectroscopy in Bonn University. Statistical analyses were made by paired t test. One hundred and forty five males with a mean age of 40.4 years and 96 females with a mean age of 42.5 years were enrolled in this study. Mean calculus weight was 4.28 gr. Mean calculus number was 4.33. Thirty four [14.1%] calculi were pure [carbonate apatite: 2, brushite: 1, uric acid: 19, cystine: 3, weddellite: 6, mono- NH4-urate: 2, struvite: 1], 207[85.6%] were mixed and none of them contained octa-caphosphate, apatite, newberyte, 2,8-dihydroxyadenine, mono-Na-urate, or xanthine. Weddellite was found in 77% of calculi. It comprised more than 50% of them in 26% of cases. Whewellite crystals were found in 78% of calculi. It comprised more than 50% of them in 46% of cases. The most common pure calculus was uric acid and the most common component of calculi was whewellite followed by weddellite. Although there is no comprehensive study on urolithiasis incidence and prevalence in Iran, it can be concluded that whewellite and weddellite may be the most common components of urolithiasis in Iran and uric acid calculi are the most common pure calculi. There was no significant difference in calculi composition in our study

Comparison of urological complications of Barry's and modified light's techniques of extravesical ureteroneocystostomy in renal transplant patients in urumieh

Between April 5, 1988 and Sept. 3, 1992, 204 cases of kidney transplantation were performed using modified Licht's implantation technique and from Sept. 4, 1992 to Sept. 3,1993,57 cases were done with Barry's method. Age ranged from 11 to 60 years and in both groups had nearly similar distribution. Kidneys were provided from live donors. Immunosuppressive therapy was similar in all patients and included cyclosporin A, azathioprine and corticosteroids. After transplantation, all patients were followed and meticulous attention was paid to determining the occurrence of possible urologic complications. Sonography, I.V.U. and/or radioisotope scanning was performed as indicated. In this study, 15 patients [7%] in the Licht group and one patient [2%] in the Barry group developed urological complications