Psychological responses to breast cancer: a qualitative study

Background and objective: Breast cancer has high incidence among Iranian women and their long term survival lead to have more challenges with cancer complication. This qualitative study aimed to identify psychological responses following breast cancer

Materials and methods: A qualitative phenomenological method has been designed for the study. A sample of 11 women with breast cancer by purposive sampling selected and semistructured in-depth interviews were conducted. The interviews were transcribed verbatim,then Information have been analyzed during 5 steps using smith's method

Results: Two main themes emerged from the interviews included basic reactions and residual reactions and The following six sub themes of despair of life, trying to find a guilty, social isolation, irritability-sensitivity, feeling incompetence and fear of disease recurrence has been determined

Conclusions: Although breast cancer is a physical disease but it has great impact on a person's mental health. Also So many psychological problems caused by breast cancer and its treatment, remains until many years after completion of therapies

[ study of frequency of nasal obstruction in migraine headaches]

Nasal congestion is a problem in which many person with migraine headache are involved and can induce misdiagnosis in these patients. Many of these patients with nasal congestion believe that the cause of their headache is due to the sinusitis. The purpose of this study was to determine the frequency of nasal congestion in episodes of migraine headache. This was a cross-sectional and descriptive study on 131 patients which were diagnosed by neurologists based on standard criteria to have had migraine. Sampling was done through non-probability in hand method. The data were gathered with regard to age, sex, type of headache and presence of nasal congestion for each patient. They were then analyzed by chi-square and Fisher's exact test [p<0/05]. Out of 131 patients 18 [13.7%] had nasal congestion in their migraine attacks. 19.8% of patients were male and 80.2 patients were female. There was no meaningful correlation between nasal congestion in migraine patients with their sex, age and type of headache. According to the results of the study there was no meaningful correlation between the type of migraine headache [classic and non-classic] and sex and age

Otomycosis in central Iran: a clinical and mycological study

Otomycosis is a fungal infection of the external ear with bothersome symptoms. The aim of this study was to evaluate the prevalence of fungal agents, predisposing factors and characteristics of patients. Between May 2008 and April 2010, 171 patients with clinical suspicion of otomycosis were enrolled and the samples from their external ear were examined for any mycological infection. Otomycosis was confirmed after mycological diagnosis in 69% of clinically suspected patients. The highest incidence of otomycosis was in autumn and in patients aged 21-40 years old. Working in dry dusty environment was a major predisposing factor. Pruritus was the most common symptom. Aspergillus flavuswas the most common fungus in otomycosis followed by A. niger, Candida albicans, A. fumigatus, A. nidulansand C. parapsilosis. Clinical suspicion of otomycosis is important to prevent unnecessary use of antibiotics. Etiology of fungal pathogens in dry dusty regions is not similar to hot humid areas and this needs to be considered in future susceptibility tests and treatment of patients with otomycosis

Evaluation of pulmonary regurgitation following tetralogy of fallot repair

Pulmonary regurgitation [PR] is the most important residual lesion remaining after the repair of Tetralogy of Fallot [TOF]. Through a thorough review of the data, statistics of patients undergoing pulmonary valve replacement following total correction for TOF and analyzing these data, the following study was performed and presented below. Database search for medical records of patients undergoing pulmonary valve replacement following total correction for TOF was performed and the data gathered, analyzed, and presented. The age of the patients [22.21 +/- 6.98 years old], time elapsed between the two operations, right ventricular ejection fraction [mildly decreased, 18.6%; moderately decreased, 67.9%; and severely decreased, 12.2% of cases], aneurysm in the outflow tract of the right ventricle [20.8%], tricuspid regurgitation [56.6%], tricuspid steno sis [1 case], valve type used for pulmonary valve replacement [biologic, 86.6%; metallic, 11.2%; and homograft, 1.9%], pulmonary artery pressure [<25mmHg, 34 cases [64.2%]; 25mmHg - 50mmHg, 7 cases [13.2%]; 50mmHg-75mmHg, 1 case [1.9%], and > 75mmHg, 1 case] were evaluated. Although right ventricular volume overload due to severe pulmonary regurgitation after repair of TOF can be tolerated for years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume overload is not eliminated or reduced, this dysfunction may be irreversible. In light of those data and with better understanding of risk factors for adverse outcomes late after TOF repair, many centers are now recommending early pulmonary valve replacement before symptoms of heart failure develop

Pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension: a report of 15 cases

Chronic thromboembolic pulmonary hypertension [CTEPH] is a serious and underdiagnosed disorder with significant morbidity and mortality. It is thought to result from single or recurrent pulmonary thromboemboli arising from the sites of venous thrombosis, often from the lower limbs. Surgical correction of anatomical obstructions [endarterectomy of pulmonary artery] is the treatment of choice in these patients, and the patients outcomes are good. The mortality rate in some centers is about 5%, but in others it is up to 30%. We started pulmonary endarterectomy in Shaheed Rajaie Heart Center [RHC] in Iran four years ago. Pulmonary thromboendarterectomy is performed under hypothermia and total circulatory arrest with cardiopulmonary bypass. All patients are evaluated in our hospital for known risk factors of deep vein thrombosis and pulmonary emboli. Right heart catheterization and measurement of pulmonary artery pressure and vascular resistance are performed in some of the patients and left heart catheterization in those who are over 45 years of age. CT angiography of the pulmonary artery with multi-slice CT scan is done in all patients before and after endarterectomy. Patient selection for successful endarterectomy is based on CT angiography and perfusion lung scan with consideration of pulmonary vascular resistance in some cases. During a 4-year period, 15 patients [5 female and 10 male] underwent this type of surgery in RHC. Their mean age was 35.87 [min. 18, max. 55] years old. The mean pulmonary artery systolic pressure by echocardiography was 87.60 mmHg [min. 55mmHg, max. 140 mmHg, SD 23.26 mmHg] and the mean pulmonary artery pressure was 46.43mmHg [min. 23 mmHg, max. 60 mmHg, SD 11.70 mmHg]. Mean surgery time was 5.33 hours [min. 4hrs, max. 14 hrs, SD. 2.46 hrs], mean bypass time was 138 minutes [min. 84, max. 220, SD=43.28 minutes], mean intubation time was 49.88 hours [min. 7 hrs, max. 216 hrs, SD 61.66 hrs], and intensive care unit stay time was 5.43 days [min. 3, max. 9, SD=1.98]. Two fatalities occurred due to bleeding and shock. The mortality rate was 20%. IVC filters were placed in a minority of the patients who had clear-cut evidence of lower extremity deep vein thrombus as a cause of pulmonary thromboembolic events. Pulmonary endarterectomy is the treatment of choice in CTEPH with an acceptable mortality rate and a good prognosis. It is possible to perform this procedure without recourse to more sophisticated evaluations with an acceptable mortality rate in patients who have segmental lobar or main pulmonary artery organized clot

Persistence of goitre in children post-salt iodization in Islamic Republic of Iran: autoimmune status

We evaluated the prevalence of autoimmune thyroiditis in a random sample of 1188 schoolchildren aged 8-13 years with normalized iodine intake in the Islamic Republic of Iran. The prevalence of goitre was 39.6%; the majority had palpable but non-visible goitre. Of a subsample of 500 children, median urinary iodine excretion [18/8 microg/dL] indicated normal iodine intake. Thyroid peroxidase [TPO] antibody was positive in 3.7% of children and was significantly correlated with the prevalence of goitre and hypothyroidism. No correlation was seen between urinary iodine excretion and positive TPO antibody, mean TPO antibody, hypothyroidism or prevalence of goitre. Autoimmune thyroiditis explains some cases of goitre but other goitrogenic factors need to be evaluated

Serum folate and vitamin B[12] status in healthy Iranian adults

To assess the serum folate and vitamin B[12] status in healthy Iranian adults, we designed a population-based cross-sectional study of 1200 individuals aged 20-80 years. Finally 984 participants [507 men and 477 women] were assessed. The mean serum folate was 4.61 [SD 2.40] ng/mL and the mean serum vitamin B[12] level was 265.6 [SD 170.9] pg/mL. Overall 1.0% were folate deficient and 25.8% had low vitamin B[12] levels according to the manufacturer's reference ranges [folate < 1.5 ng/mL and vitamin B[12] < 160 pg/mL]. The mean serum folate and vitamin B[12] levels were significantly lower in men. The prevalence of vitamin B[12] deficiency was considerably higher than folate deficiency. Implementation of preventive measures seems to be necessary

[ effects of hydrogen peroxide solution and tetracycline ointment in healing of traumatic facial wounds: a comparative study]

Wound repair after a surgical operation or traumatic injuries is a coordinated process, which is highly dependent to the pre- and post-operative or traumatic care. There is no consensus on the best wound care method and application of topical therapeutic agents including diluted oxygen peroxide solution and antibiotics. This study is aimed to compare the healing effects of oxygen peroxide and tetracycline ointment in management of traumatic facial injuries. 76 patients divided into two groups were entered into this randomized clinical trial. All patients sustained facial injuries requiring primary repair. The first group received 2% topical oxygen peroxide solution for 5 days, and the second group received sterile 1% tetracycline topical ointment for 5days. At the end of the fourth day, wound healing status was assessed with a chart designed for this purpose. No statistically significant difference was observed between the tetracycline and hydrogen peroxide groups in regards to the distance of wound margins, erythema and dehiscence. According to our results, there is no difference in the effects of hydrogen peroxide solution or tetracycline ointment on the healing of traumatic facial wounds

[ survey of occlusion and oro-jaw-facial cephalogmetric Indices in 6-12 year old children with adenoid enlagement]

Enlargement of Adenoid is one of the most common disorders in childhood affecting different aspects of oral and dental health and quality of life. As a result of frequent respiratory infections, allergy, nasal septum deviation and choronic sinusitis due to adenoid enlargement, facial height, gonial angle, overjet and overbite undergo changes. The purpose of this study was to assess the effect of adenoid enlargement on oro-jaw-facial cephalometric Indices and occlusion. In this cross-sectional analytical study, 96 children [6-12 years old] with adenoid enlargement [case group] and 96 children with normal size adenoid [control group] were randomly selected among patients referring to Khorasgan dental school and ENT clinics and different hospitals in Isfahan. Variables of overjet, overbite, open bite, mouth breathing, lip incompetency, gingivitis, SNA, SNB, ANB, gonial angles and facial height in two groups were evaluated. The data were analysed by chi-square and t-tests using SPSS version 9 software. The differences in anterior facial height, anterior/posterior facial height, gonial angle, SNB, overjet, snoring, mouth breathing, gingivitis and posterior crossbite between case and control groups were significant [P<0.05]. Adenoid enlargement induces some oromaxillofacial changes which inturn affect the region functionally and esthetically. The severity of these changes depends on the level of adenoid enlargement, time length of changes and induced mouth breathing duration versus normal growth and development maintenance mechanisms as well as the practitioner's interventional strategies

Comparison of actions of botulinum toxin A, between two frontal injections

Beautiful appearance is important for many people particularly with aging. Botulinum A toxin has been used for cosmetic purposes for several years. One of its applications is removal of hyper dynamic facial lines. Its use is very popular due to cheaper and more simplicity, compared to the surgical methods. Also most patients are interested to using it for the second time. Therefore, the aim of this study was to evaluate in the onset and duration of action of this toxin, following the first and the second injection compared to the first injection. This interventional study, was carried out on 61 patients [48 females and 13 males] referred to Al-Zahra and Kashani hospitals of Isfahan for treatment of their facial hyper dynamic lines. At the first visit, 25 units of botulinum were injected at 5 points of the face of the patients and followed up for 6 months. At the end of 6 months, the second injection was administrated to the available patients [25 individuals] using the same dose of toxin and locations. The onset and duration of action in the two periods were recorded. The data was analyzed using t-test. The onsets of clinical actions following the first and the second injections were 3.1 +/- 0.77 and 1.5 +/- 0.41 days, respectively [p<0.001]. Means of the duration of action for the first and the second injection were 14 +/- 2 and 18 +/- 2 weeks, respectively [p>0.05]. The onset of action for the second injection was faster. However, there was no significant difference in duration of action between the two injections

[Use of the omentum flap for reconstruction of large chest wall defects]

Use of alloplastic material such as Gore-Tex and loco regional flaps for reconstruction of the large defects of chest wall has been well described. The purpose of this article is to present a useful technique of using the pediculated omental flap to cover the large chest wall defects. Three patients with large thoracic wall defects underwent reconstruction with omental flap with or without prolene mesh. These defects resulted from tumor resection. Their dimensions ranged from 25x30cm to 35x50cm. The omentum was tunneled through a separate opening in the abdominal wall into the subcutaneous plane and used to cover the defect and inner surface of prolene mesh. There was no complication and all wounds healed with no recurrence. The patients were followed for two years and there was no tumor recurrence or wound breakdown. Omental flap is a reasonable alternative for chest wall reconstruction especially when delay wound healing anticipated or when others loco regional flap are not appropriate

Comparison of validity of decision rules in identifying primary osteoporosis in post menopausal women: a comparison

Clinical decision rules have been designed and developed to assist physicians in identifying the patient with osteoporosis. The aim of this study was to evaluate the performance of three decision rules in an Iranian post menopausal population. Three osteoporosis risk indices, the osteoporosis self assessment tool [OST], osteoporosis risk assessment instrument [ORAI], and the body weight criterion for 5573 out patients without any risk factors for secondary osteoporosis or receiving active bone medication and with negative history of prior fragility fraction were calculated. BMD at spines and femoral neck were measured via dual x-ray absorptiomety and the patients categorized to normal, osteopenic and osteoporotic according to WHO criteria. The sensivity, specifity, positive predictive value negative, predication value and area under receiver operating curve in identifying the osteoporotic women were determined for each decision rule and compared. In this study, the prevalence of osteoporosis was 30.8%, 20% in lumbar spines and neck of femur, respectively. The sensivity of these risk indices in indentifying women with osteoporosis ranged from 70% to 84/1% and the specificity ranged from 44.6-65.6%. The area under curve [ROC] in identifying those patients with osteoporosis was significantly better for OST [0.75] and ORAI [0.74] compared with the body weight criteria [0.66]. The negative predicative value ranged from 80% to 93%, while positive predication values ranged from 33% to 54%. Our data provide evidence showing OST, ORAI to be useful clinical tools, assisting clinicians in making decisions regarding which women need to be to referred for BMD testing but more evidence however needed is to confirm validity of body weight criterion

Effect of menopause and renal function on vitamin D status in Iranian women

The effects of menopause and renal function on serum parameters of the vitamin D-endocrine system were studied in a cross-sectional sample of 676 healthy women aged 20-74 years in Shiraz. Low serum 25-hydroxyvitamin D [25-OHD] was found in 52.9% of the women. Serum parathyroid hormone [PTH] increased significantly over the age span in premenopausal women [r= 0.13, P= 0.02]. In premenopausal and postmenopausal women, serum levels of 25-OHD, phosphorus and calcium were stable across the age span. There was no significant correlation between creatinine clearance or serum PTH [r= -0.016, P= 0.66] and 25-OHD [r= 0.012, P= 0.74]. The high prevalence of vitamin D deficiency warrants consideration of dietary supplementation

Hyperglycemic crises in diabetic patients

Diabetic ketoacidosis [DKA] and hyperosmolar hyperglycemic state [HHS] are two important causes of mortality and morbidity in patients with diabetes. Mortality rates are <5% in DKA and about 15% in HHS, much of which are avoidable with appropriate management. The prognosis is worsened with aging, hypotension, coma and concomitant life-threatening illnesses. The criteria for DKA and HHS are somewhat arbitrary, although glucose level is higher and ketone body level is minimal in HHS, they are two extremes in a spectrum of diabetic metabolic decompensation. In general, DKA occurs in type 1 and most often HHS occurs in type 2 diabetes; however, each type of diabetes may be associated with DKA or HHS. Both conditions are associated with marked dehydration, electrolyte disturbances and insulin deficiency and increased counter-regulatory hormones, so treatment consists of water and electrolyte replacement and insulin administration. Recognition and treatment of precipitating factors and frequent monitoring of patients are considered the most crucial aspects of the management

Microbiology and antimicrobial resistance in chronic resistant rhino sinusitis with or without polyp after functional endoscopic sinus surgery

The purpose of this study was microbiology of chronic resistant rhino sinusitis with or without nasal polyp in patients undergoing functional endoscopic sinus surgery and antimicrobial resistance testing. In a cross-sectional study during December 2000 to June 2002, 94 CRS patients with or without nasal polyp were sampled through FESS for microbiology culture and In-vivo antimicrobial resistance was tested in both groups. In CRS group with polyps [42 patients], the most common isolated organisms were Staph. coagulase-negative [26.2%], Staph. areous [23.8%], E-Coli [16.7%], Klebsiella [14.3%] and Enterobacter [7.1%]. In CRS group without polyps [52 patients], the most common isolated organisms were Staph. coagulase-negative [25%], Staph. areous [11.5%], Klebsiella [9.6%], E-Coli [7.7%] and Strep. Non-group A [7.7%]. Normal flora grew in 5 cultures [9.6%]. In only one culture of CRS group without polyp, Pseudomonas was isolated. No resistance was reported from gram-positive bacteria against vancomycin and gram-negative rods were sensitive to ciprofloxacin, ceftriaxon and ceftizoxim. Despite of some previous studies, the most common micro- organisms in the cultures of CRS cases, regardless of having nasal polyps or not, were Staph. coagulase-negative, Staph. aureus and gram-negative rods, respectively. The incidence of GNRs in CRS group with nasal polyps is higher which may lead to special antibiotic therapy in them. Increasing in Vivo resistance of these bacteria to antibiotics is problematic and the routine old antimicrobial therapy may not be effective enough to control these pathogens and avoid surgical therapy. However, In Vivo evaluations are recommended to reveal a better interpretation

Hyperhomocysteinaemia, hyperlipidaemia and risk of venous thromboembolism in Shiraz

To assess the risk of venous thromboembolism [VTE] associated with hyperhomocysteinaemia [hyper-Hcy] and hyperlipidaemia, we performed a case-control study. Fasting total homocysteine [Hcy], triglyceride and cholesterol levels were assessed in 43 patients with VTE and 43 controls. Mean Hcy level was significantly higher in the test group. Odds ratio [OR] for VTE in patients with hyper-Hcy was 2.7, with the association stronger in women and those under 50. The OR for those with both hypertriglyceridaemia and hypercholesterolaemia was significantly greater in those under 50. Increased risk for venous thrombosis was found among those under 50 having both lipid abnormalities

Water and creatinine clearance in thyrotoxicosis

In thyrotoxicosis, changes in urine output and serum creatinine [Cr] concentration has been related to increased glomerular filtration rate [GFR]. The aim of this study is to clarify the mechanism of these changes. Forty-one thyrotoxic patients, 9 male and 32 female with the age range of 16-62 years were selected and body weight, 24-h urine output, serum and urine Cr concentration, and GFR were measured in the thyrotoxic state and two months after treatment. The data was analyzed by student 't' test and paired 't' test. The following parameters were measured and are compared in thyrotoxic and euthyroid states respectively. Body weight: 58.4 +/- 10.6 Kg and 61.6 +/- 10.4 Kg after receiving anti-thyroid therapy [p<0.001]. 24-h urine output: 1430 +/- 420 ml, and 1165 +/- 450 ml [p <0.001]. Serum creatinine concentration: 0.7 +/- 0.11 mg/dl, and 0.84 +/- 0.13 mg/dl [p<0.001]. 24-h urine creatinine concentration: 906 +/- 225 mg/l and 1081 +/- 285 mg/l [p<0.001]. The change in GFR was not statistically significant, being 90.1 ml/min before therapy and 89.5 ml/min in the euthyroid state. Increased urine output and decreased serum creatinine concentration in thyrotoxicosis is not GFR related

effect of levothyroxine therapy on the recurrence rate of goiter after subtotal thyroidectomy in iodine deficient area

One hundred and two patients with subtotal thyroidectomy performed for benign thyromegaly were studied in Fars province, an area of iodine deficiency in southern of Iran. Group A, 40 patients who received levothyroxine 100mg per day postoperatively. Group B, 62 patients who did not receive levothyroxine. The recurrence rates were 5% and 47% in groups A and B respectively. The recurrence rate was higher in patients with multinodular goiter and diffuse thyromegaly than those with a single nodule. This study indicates that in iodine deficient areas, the patients should receive levothyroxine post-operatively for prevention of recurrence until iodine supplementation is available for the whole population