Temporal and Geographical Trends of Incidence of Thyroid Cancer in Golestan, Iran, 2004-2013.

BACKGROUND: Thyroid cancer is the most common type of endocrine cancer. We aimed to determine the incidence rates of thyroid cancer across a 10-year period (2004-2013) in Golestan, Iran. METHODS: We obtained the thyroid cancer data from Golestan Population-Based Cancer Registry (GPCR). Age-standardized incidence rates (ASR) were calculated and reported per 100000 person-years. The Joinpoint software was used to assess time trends, and average annual percent changes (AAPCs) and their corresponding 95% confidence intervals (CIs) were reported. RESULTS: Of 326 registered patients, 83 (25.5%) were men and 243 (74.5%) were women. The mean age was 51.3 and 42.6 years for males and females, respectively. Overall, the ASR of thyroid cancer was 2.2 per 100000 person-year (AAPC = 2.76; 95% CI: -3.68 to 9.64). The test of co-incidence showed a statistically significant difference in the incidence of thyroid cancer between men (1.3) and women (3.2) (P < 0.001). According to our results, the ASR of thyroid cancer in western parts of Golestan is higher, including Gorgan and Aliabad cities. CONCLUSION: Increasing trends in incidence rates of thyroid cancer were found in the Golestan province during the study period, especially in women. We found significantly higher rates of thyroid cancer in women. Geographical diversities were seen in incidence rates of thyroid cancer in the Golestan province. Our results may be helpful for designing further researches to investigate the epidemiological aspects of thyroid cancer in the Golestan province.

Increasing trends of lung cancer in Golestan province, Northern Iran (2004-2016).

INTRODUCTION: We aimed to present the time trends and geographical distribution of lung cancer in Golestan province, a high-risk area for pulmonary tuberculosis (TB) in Northern Iran (2004-2016). METHODS: Data on incident primary lung cancers were obtained from the Golestan population-based cancer registry. The data were analyzed by CanReg-5 software to calculate the age-standardized incidence rates (ASRs). We used Joinpoint software for time trend analysis. Average annual percent changes were calculated. The contribution of population aging, population growth and risk to the overall changes in incidence of lung cancer were determined using partitioning analysis. RESULTS: Overall, 1829 cases of lung cancer were registered by the GPCR during 2004-2016, of which 1274 (69.7%, ASR in 2016 = 21.3) were men and 555 (30.3%, ASR in 2016 = 11.4) were women. The results of Joinpoint regression suggested a significant increasing trend in incidence of lung cancer in Golestan province during 2004 and 2016 (AAPC = 3.74; p-value = 0.01) with more prominent increasing in rural population (AAPC = 4.93; p-value<0.01). The number of new cases of lung cancer increased by 131.6% (from 98 in 2004 to 227 in 2016), of which 34.1%, 22.3% and 75.3% were due to population size, population aging and risk, respectively. Hot points of lung cancer were found in western parts of the Golestan. CONCLUSION: With high incidence rates and increasing trends of lung cancer, further studies are warranted to clarify the role of TB and other risk factors on its burden in this population.

Marked increase in breast cancer incidence in young women: A 10-year study from Northern Iran, 2004-2013.

INTRODUCTION: Breast cancer is the most frequent cancer among women worldwide. Breast cancer incidence in young women is a health issue of concern, especially in middle-income countries such as Iran. The aim of this study is to report the breast cancer incidence variations in Golestan province, Iran, over a 10-year period (2004-2013). METHODS: We analyzed data from the Golestan Population-based Cancer Registry (GPCR), which is a high-quality cancer registry collecting data on primary cancers based on standard protocols throughout the Golestan province. Age-standardized incidence rates (ASRs) and age-specific incidence rates per 100,000 person-years were calculated. Time trends in ASRs and age-specific rates were evaluated using Joinpoint regressions. The average annual percentage change (AAPC) with correspondence 95% confidence intervals (95%CIs) were calculated. RESULTS: A total of 2106 new breast cancer cases were diagnosed during the study period. Most cases occurred in women living in urban areas: 1449 cases (68%) versus 657 cases (31%) in rural areas. Statistically significant increasing trends were observed over the 10-year study period amongst women of all ages (AAPC = 4.4; 95%CI: 1.2-7.8) as well as amongst women in the age groups 20-29 years (AAPC = 10.0; 95%CI: 1.7-19.0) and 30-39 years (AAPC = 5.1; 95%CI: 1.4-9.0). CONCLUSION: The incidence of breast cancer increased between 2004 and 2013 in Golestan province amongst all age groups, and in particular amongst women aged 20-39 years. Breast cancer should be considered a high priority for health policy making in our community.

Epidemiology of Head and Neck Cancers in Northern Iran: A 10-Year Trend Study From Golestan Province.

BACKGROUND: Golestan province, in Northern Iran, is a high-risk area for esophageal squamous cell carcinoma (SCC). SCC is also the most common histological type of cancers of the head and neck region including cancers of oral cavity, oropharynx, hypopharynx and larynx. We aimed to present the incidence rate of head and neck SCC (HNSCC) in Golestan province during 2004 and 2013. METHODS: Data on HNSCC were obtained from Golestan population-based cancer registry (GPCR). Quality control and data analysis were performed using CanReg software. Age standardized incidence rates (ASRs) were calculated using the world standard population. The ASRs were presented per 100000 person-years for different genders, residence places and years. RESULTS: During the 10-year period from 2004-2013, 434 cases of HNSCC were registered. 327 (75.3%) of these cases were male, 51.2% (222 cases) lived in urban areas and 351 (80.9%) of the total HNSCCs occurred in the larynx. Overall, the ASR of HNSCCs in Golestan province was 4.8. The ASR of HNSCCs was more than two-fold higher in male (6.6) than female (3.0). Our results showed an increasing trend in ASR of larynx cancer during the study period both in male and female. CONCLUSION: We found relatively high rates of larynx cancer in Golestan province. Our results also showed higher rates of HNSCC in males and urban population. Considering common risk factors between HNSCCs and esophageal cancer, further studies are needed to clarify different aspects of HNSCCs (including epidemiology and risk factors) in this high-risk population.

Subtypes of Benign Breast Disease as a Risk Factor of Breast Cancer: A Systematic Review and Meta Analyses.

BACKGROUND: Researchers suggest that benign breast disease (BBD) is a key risk factor for breast cancer. The present study aimed to determinate the risk level of breast cancer in terms of various BBD subgroups. METHODS: A meta-analysis was performed to determinate the risk of breast cancer associated with BBD. Observational studies (traditional case-control studies, nested case-control studies, and cohort studies) published from January 2000 to June 2015 were assessed to evaluate the risk of developing breast cancer related to BBD. Various databases such as Medline (PubMed), Web of Science (ISI), Scopus, and Google Scholar were searched. The additional search included the Journal of Breast Cancer Research and Treatment and the Journal of Cancer Research. RESULTS: Twenty studies out of 21 were used to estimate the risk of developing breast cancer related to proliferative disease without atypia versus non-proliferative disease and the reported risk ranged from 1.04 to 1.83. The reported risk of developing breast cancer related to proliferative disease with atypia versus non-proliferative disease in 21 studies ranged from 1.59 to 4.74. Based on 20 studies, the pooled risk estimates for developing breast cancer related to proliferative disease without atypia versus non-proliferative disease was 1.58 (95% CI: 1.51-1.66). Based on 21 studies, the pooled risk estimates for developing breast cancer related to proliferative disease with atypia versus non-proliferative disease was 3.49 (95% CI: 3.23-3.77). CONCLUSION: The overall result of this review showed an elevated risk for breast cancer related to BBD subtypes. We propose better strategies for screening recommendations for such women.

Subtypes of Benign Breast Disease as a Risk Factor for Breast Cancer: A Systematic Review and Meta-Analysis Protocol.

Breast cancer is a multifactorial disease. Benign breast disease (BBD) is one of the most important risk factors for breast cancer. The etiology of BBD is unknown. It is divided into nonproliferative and proliferative diseases. The selection of studies will be based on titles, abstract screening, inclusion and exclusion criteria, and quality assessment. Previous studies have shown that all types of BBD increase the risk of breast cancer, but the risk degree is different for each one. Accurate risk estimation of breast cancer in each category can be very important for proper clinical management. This systematic review and meta-analysis will be conducted on observational studies (traditional case control, nested case control, case cohort, and cohort) published in the Web of Science (ISI), PubMed (MEDLINE), Scopus, Google Scholar, and the key journals of this field such as Breast Cancer Research and Treatment and Cancer Research from January 2000 to June 2015. Reference lists and gray literature will be reviewed too. All the initial retrievals will be performed by 2 researchers independently. The data extraction form will consist of general information concerning the studies, study eligibility, method, risk of bias assessment, and results-including odds ratios, risk ratios, rate ratios, and hazard ratios. The PRISMA and MOOSE guidelines will be used to report our findings. Registration Details: PROSPERO-42016035243.

Haplotype Analysis of DXS548 and FRAXAC1 Microsatellite Loci in Iranian Patients with Fragile X Syndrome.

OBJECTIVE: Fragile X syndrome (FXS) is the most common cause of inherited mental retardation caused by expansion of a (CGG) repeat region up to 1000 repeat in 5' region of the FMR1 gene located in FRAXA locus Xq27.3. To better understand the mechanism involved in expansion of CGG region, the molecular characteristic of the flanking microsatellite markers in the region must be clarify in different populations. We aimed to examine the potential association between specific haplotype and the expanded AC-repeat region in cases and controls chromosomes. MATERIALS & METHODS: Forty unrelated FXS males and 62 unrelated normal males originating from various regions of Iran were haplotyped by analyzing two CA-repeat markers, FRAXAC1 and DXS548. RESULTS: Significant linkage disequilibrium was obtained between DXS548 and FRAXAC1 specific marker alleles and CGG repeat expansion among 40 fragile X cases compared to 62 normal controls. The frequencies of DXS548 and FRAXAC1 longer alleles in patients were significantly higher than that in control group. Two FRAXAC1 long alleles were only observed in cases, possibly due to concatenated mutations. The increase of heterozygosities in fragile X cases (DXS548 78.6%, FRAXAC1 64.6%) in comparison to the controls (DXS548 63.0%, FRAXAC1 47.0%) showed a multimodal distribution of fragile X associated alleles. CONCLUSION: Haplotype analyses with DXS548 and FRAXAC1 markers represented that haplotype distribution in the normal controls and FXS patients were significantly different, representing a weak founder effect.

Suitable intravenous fluid for preventing dysnatremia in children with gastroenteritis; a randomized clinical trial.

INTRODUCTION: Gastroenteritis (GE) is one of the most common pediatric diseases. Hyponatremia commonly occurs by administering hypotonic fluids to GE and hospitalized children. Yet, there is no consensus on the ideal method of treatment. OBJECTIVES: we aimed to assess suitable intravenous (IV) fluid for preventing dysnatremia in children with GE. PATIENTS AND METHODS: This is a double blind randomized clinical trial, which was conducted on infants of 6 months up to 14 years children with GE. Children were randomly assigned in 2 different groups. Group A; received 20 cc/kg 0.9% isotonic saline as a bolus, and 0.45% hypotonic saline as sum of maintenance fluid and volume deficit. Group B was treated with the same bolus and 0.9% isotonic saline with 20 mEq/L KCl as sum of maintenance fluid and volume deficit. Blood and urine samples were taken at admission, 4 and 24 hours. Data were analyzed by independent t test, Mann-Whitney U test, Friedmann test, chi-square and 2-tailed repeated measurements by SPSS version 19. RESULTS: Baseline hyponatremia and isonatremia were detected in 24 (31.5%) and 51 (67.1%) patients, respectively. Mean level of sodium at T0, T4 and T 24 mentioned no significant difference between groups. No hypernatremia was noted by administering isotonic saline. RESULTS showed that 4 and 24 hours after administration isotonic saline, the mean plasma sodium differed significantly in baseline hyponatremic patients. However, no significant difference was noted after 4 and 24 hours in group A. CONCLUSION: According to the considerable effect of isotonic saline on hyponatremic patients, it seems that administering isotonic fluids regardless of the types of dysnatremia can be recommended to lessen clinicians' conflicting decision-making in selecting an appropriate fluid.

Comparison of sexual dysfunction in women with infertility and without infertility referred to Al-Zahra Hospital in 2013-2014.

BACKGROUND: One of the affected aspects in infertile women that have not been given sufficient attention is sexual function. Sexual function is a key factor in physical and marital health, and sexual dysfunction could significantly lower the quality of life. Aim of this study was to assess the comparison sexual dysfunction in women with infertility and without infertility, admitted to Al- Zahra Hospital. OBJECTIVE: We decided to assess the prevalence of women sexual disorders in fertile and infertile subjects, admitted to Al-Zahra Hospital. MATERIALS AND METHODS: 149 fertile and 147 infertile women who referred to infertility clinic of Al-Zahra Hospital during 2013-2014 were entered this cross-sectional study and Female Sexual Function Index questionnaire (FSFI) had been filled by all the cases. Most of women were married for 6-10 years (35.5%) and mean marriage time in participants was 9.55±6.07 years. Data were analyzed using SPSS software Ver. 18 and (2) test and logistic regression model has been used for analysis. RESULTS: Results showed significant differences between desire (p=0.004), arousal (p=0.001), satisfaction (p=0.022) and total sexual dysfunction (p=0.011) in both groups but in lubrication (p=0.266), orgasm (p=0.61) and pain (p=0.793) difference were not significant. CONCLUSION: Some of sexual dysfunction indices are high in all infertile women. Our findings suggest that infertility impacts on women's sexual function in desire, arousal, satisfaction and total sexual dysfunction. Health care professional should be sensitive to impact that diagnosis of infertility can have on women's sexuality.

Comparison between Unilateral and Bilateral Ovarian Drilling in Clomiphene Citrate Resistance Polycystic Ovary Syndrome Patients: A Randomized Clinical Trial of Efficacy.

BACKGROUND: Laparoscopic ovarian drilling (LOD) is an alternative method to induce ovulation in polycystic ovary syndrome (PCOS) patients with clomiphene citrate (CC) resistant instead of gonadotropins. This study aimed to compare the efficacy of unilateral LOD (ULOD) versus bilateral LOD (BLOD) in CC resistance PCOS patients in terms of ovulation and pregnancy rates. MATERIALS AND METHODS: In a prospective randomized clinical trial study, we included 100 PCOS patients with CC resistance attending to Al-Zahra Hospital in Rasht, Guilan Province, Iran, from June 2011 to July 2012. Patients were randomly divided into two ULOD and BLOD groups with equal numbers. The clinical and biochemical responses on ovulation and pregnancy rates were assessed over a 6-month follow-up period. RESULTS: Differences in baseline characteristics of patients between two groups prior to laparoscopy were not significant (p>0.05). There were no significant differences between the two groups in terms of clinical and biochemical responses, spontaneous menstruation (66.1 vs. 71.1%), spontaneous ovulation rate (60 vs. 64.4%), and pregnancy rate (33.1 vs. 40%) (p>0.05). Following drilling, there was a significant decrease in mean serum concentrations of luteinizing hormone (LH) (p=0.001) and testosterone (p=0.001) in both the groups. Mean decrease in serum LH (p=0.322) and testosterone concentrations (p=0.079) were not statistically significant between two groups. Mean serum level of follicle stimulating hormone (FSH) did not change significantly in two groups after LOD (p>0.05). CONCLUSION: Based on results of this study, ULOD seems to be equally efficacious as BLOD in terms of ovulation and pregnancy rates (Registration Number: IRCT138903291306N2).

Correlation of the Ratio of Upper Third to Lower Third Circumferences of the Chest with Obstructive Pattern in Spirometry.

BACKGROUND: Obstructive Lung Diseases (OLDs), could lead to progressive hyperinflation of the lungs that cause increased work of breathing, impaired gas exchanges and functional limitations in patients. In this study, thoracic circumference of patients in upper and lower third were measured directly and the association of the upper to lower third width of chest with spirometric parameters was evaluated. MATERIALS AND METHODS: In this cross-sectional study, five hundred twenty nine consecutive patients, with obstructive pattern in spirometry (FEV1/FEVC<70% and FEV1<80%), and 143 controls with normal spirometry were entered. Demographic and clinical data including age, sex, smoking, type, duration and severity of disease and spirometric characteristics were recorded. Upper Third circumference of Chest (UTCC) at axillary level, and Lower Third circumference of Chest (LTCC) at lower rib edge, were measured with an ordinary tape meter. Asthma Control Test (ACT) questionnaire for asthmatic and COPD Assessment Test (CAT) questionnaire in COPD patients were completed. RESULTS: We found that in patients with UTCC/LTCC ratio > 0.8, UTCC had significant correlation with FEV1 and FEV1/FVC (R: 0.069, 0.055); Moreover significant correlation was found in UTCC, LTCC and UTCC/LTCC ratio with ACT score in this subgroup (R: -0.123, -0.092, -0.124)On the other hand in patients with UTCC/LTCC ratio > 0.9, UTCC and LTCC had significant correlation with FEV1 (R: 0.07, 0.051). CONCLUSION: UTCC/LTCC ratio > 0.8, may be a predictor of obstructive pattern in patients. This is more important in some occations, for example during preoprative evaluation of a patient in an emergency conditions which there is no enough time for performing appropriate diagnostic tests such as spirometry to reveal the type and severity of obstructive pulmonary diseases.

Comparison of 25 µg sublingual and 50 µg intravaginal misoprostol for cervical ripening and labor: a randomized controlled equivalence trial.

BACKGROUND: Sublingual misoprostol, used for labor induction, produces earlier and higher peak plasma concentrations of misoprostol than vaginal or rectal misoprostol. The sublingual route could be expected to be more effective and safer than the vaginal route and by avoiding a direct effect on the cervix, it might reduce the risk of uterine hyperstimulation and be safer. This study aimed to compare the efficacy of 25-µg sublingual misoprostol with 50-µg intravaginal misoprostol for cervical ripening prior to labor induction in primiparous women. METHODS: In a double-blind, parallel randomized controlled equivalence trial, we recruited 131 primiparous women at 36-42 weeks of gestation requiring labor induction who referred to Alzahara hospital in Rasht, Iran. The women were randomly assigned to receive 25-µg sublingual misoprostol with vaginal placebo (n = 63) or 50-µg intravaginal misoprostol with sublingual placebo (n = 63). The dose was repeated every 4 h (maximum 4 doses). The primary outcome was the interval from the start of induction to vaginal delivery. RESULTS: There were no significant differences between the two groups with regard to the interval from the start of induction to vaginal delivery(13.2 ± 3.07 h in the vaginal group vs. 13.1 ± 3.46 h in the sublingual group), duration of active phase, Bishop Scores after 4h, and rate of the vaginal delivery under 12 h. Also, the rate of hyperstimulation, tachysystole, type of delivery, cause of cesarean section, Apgar scores less than 7 and admission to the NICU were similar in these two groups. The mean dose of misoprostol applied was significantly lower in the sublingual group (P = 0.001). CONCLUSION: Sublingual administration of 25-µg of misoprostol appears to be as effective as 50 µg intravaginal misoprostol for cervical ripening and labor induction. TRIAL REGISTRATION: This trial has been registered under IRCT 38903131096N3.

Predictive value of aspartate aminotransferase and alanine aminotransferase levels in vaginal fluid for the diagnosis of premature rupture of membranes.

BACKGROUND: Preterm premature rupture of membranes (PPROM) occurs in 3% of pregnancies and 30-40% of preterm labors are related to this problem. Early diagnosis of PPROM is very important due to its impact on pregnancy outcomes. OBJECTIVE: To determine the diagnostic value of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels in vaginal fluid for the diagnosis of preterm premature rupture of membranes as a non-invasive and available test. MATERIALS AND METHODS: A total of 148 pregnant women between the 26(th)-36(th) gestational weeks were enrolled in the study. 74 patients were in PROM group and 74 in control group. AST and ALT levels in vaginal fluid were measured in each group. Mann Whitney U-test was used to compare AST and ALT levels in each group. RESULTS: The mean of AST level in vaginal fluid was 12.77±10.06 in PROM group vs. 6.91±10.92 in control group (p<0.001), while there were no significant difference between ALT levels in PROM group 1.51±3.17 and control group 0.89±1.15 (p=0.49). Optimal cut point of AST for the diagnosis of PROM was 4.5 IU/L in this study. The sensitivity, specificity, positive and negative predictive values were 82.4%, 63.5%, 69.32% and 78.33% respectively. CONCLUSION: According to the findings of this study, measurement of AST level in vaginal fluid can be used as a reliable test for diagnosis of PROM, but there is no good cut point for ALT level that can be practically used.

The Prevalence, Risk Factors, and Clinical Correlates of Erosive Esophagitis and Barrett's Esophagus in Iranian Patients with Reflux Symptoms.

Background. Erosive esophagitis (EE) and Barrett's esophagus (BE) are the two important complications of gastroesophageal reflux disease. We aimed to investigate the prevalence of and the risk factors for EE and BE in an Iranian group of patients with reflux symptoms. We also examined the relationship between reflux symptoms and endoscopic findings. Methods. A total of 736 patients with gastroesophageal reflux disease (GERD) symptoms were enrolled and all underwent upper gastrointestinal endoscopy. Diagnosis of Barrett's esophagus was confirmed by pathologic examination and Helicobacter pylori (H. pylori) infection was demonstrated by rapid urease test. Results. Two hundred eighty-three and 34 patients were found to have EE and BE, respectively. Multivariate analysis showed that hiatal hernia (P < 0.001) and H. pylori infection (P < 0.002) were the two significantly related risk factors for esophagitis. Only age was related to BE, with BE patients being more likely to be older (P < 0.001) than others. Conclusions. Prevalence of EE and BE in Iranian reflux patients is similar to that seen in western countries. H. pylori infection and the presence of hiatal hernia may be strong risk factors for esophagitis as does older age for Barrett's esophagus. Finally, reflux symptoms have no significant relationship with endoscopic findings.

Comparison of high-resolution and standard zoom imaging modes in cone beam computed tomography for detection of longitudinal root fracture: An in vitro study.

PURPOSE: The purpose of this study was to compare the efficacy of two imaging modes in a cone beam computed tomography (CBCT) system in detecting root fracture in endodontically-treated teeth with fiber posts or screw posts by selecting two fields of view. MATERIALS AND METHODS: In this study, 78 endodontically-treated single canal premolars were included. A post space was created in all of them. Then the teeth were randomly set in one of 6 artificial dental arches. In 39 of the 78 teeth set in the 6 dental arches, a root fracture was intentionally created. Next, a fiber post and a screw post were cemented into 26 teeth having equal the root fractures. High resolution (HiRes) and standard zoom images were provided by a CBCT device. Upon considering the reconstructed images, two observers in agreement with each other confirmed the presence or absence of root fracture. A McNemar test was used for comparing the results of the two modes. RESULTS: The frequency of making a correct diagnosis using the HiRes zoom imaging mode was 71.8% and in standard zoom was 59%. The overall sensitivity and specificity in diagnosing root fracture in the HiRes mode were 71.79% and 46.15% and in the standard zoom modes were 58.97% and 33.33%, respectively. CONCLUSION: There were no significant differences between the diagnostic values of the two imaging modes used in the diagnosis of root fracture or in the presence of root canal restorations. In both modes, the most true-positive results were reported in the post space group.

Quality of publication ethics in the instructions to the authors of Iranian journals of medical sciences.

Providing a perfect instruction to authors can prevent most potential publication ethics errors. This study was conducted to determine the quality of ethical considerations in the instructions to the authors of Iranian research scientific journals of medical sciences (accredited by the Commission for Accreditation and Improvement of Iranian Medical Journals) in October 2011. Checklist items (n=15) were extracted from the national manual of ethics in medical research publications, and the validity of the manual of ethics was assessed. All the accredited Iranian journals of medical sciences (n=198) were entered into the study. The instructions to the authors of 160 accredited Iranian journals were available online and were reviewed. The ANOVA and Kendall Correlation coefficient were performed to analyze the results. A total of 76 (47.5%) of the 160 journals were in English and 84 (52.5%) were in Farsi. The most frequently mentioned items related to publication ethics comprised "commitment not to send manuscripts to other journals and re-publish manuscripts" (85%, 83.8%), "aim and scope" of the journal (81.9%), "principles of medical ethics in the use of human samples" (74.4%), and "review process" (74.4%). On the other hand, the items of "principles of advertising" (1.2%), "authorship criteria" (15%), and "integrity in publication of clinical trial results" (30.6%) were the least frequently mentioned ones. Based on the study findings, the quality of publication ethics, as instructed to the authors, can improve the quality of the journals.

Perinatal outcomes of pregnancies with borderline versus normal amniotic fluid index.

BACKGROUND: Amniotic fluid is an indicator of placental function on the fetal development. The amniotic fluid index is the most commonly used method of measuring amniotic fluid. OBJECTIVE: The purpose of this study was to compare the pregnancy outcomes of a borderline versus normal AFI. MATERIALS AND METHODS: This cross-sectional study was carried out on a total of 235 pregnant women referred to Alzahra Medical Center between 2009-2011. Women with a singleton pregnancy in third trimester were enrolled into this study; of these subjects, 141 cases were in normal AFI group and 94 cases in borderline AFI group. Adequate information was obtained from the patients' medical record and the groups were compared on maternal and fetal complications. Data analysis was performed by using SPSS. RESULTS: The mean maternal age in borderline AFI group was 25.96±5.92 years and in normal AFI group was 27.88±6.5 years (p=0.023). Maternal outcomes such as preterm delivery and labor induction in women with borderline AFI were considerably higher than those in normal group (p=0.01 and p=0.001). There were no significant differences between the two groups in terms of high blood pressure, preeclampsia, diabetes and neonatal respiratory distress. The borderline AFI group had higher rate of neonatal complications such as Apgar score of less than 7 (p=0.004), IUGR (0.0001), LBW (0.001), and crucial need to NICU (0.003). CONCLUSION: Findings indicated that there are statistical differences between adverse outcomes in borderline AFI group and normal group. This article extracted from M.D. thesis. (Samira Naimian).

Diagnostic value of two modes of cone-beam computed tomography in evaluation of simulated external root resorption: an in vitro study.

PURPOSE: Field of view and voxel resolution of cone beam computed tomography (CBCT) might affect the diagnostic capability. This study was performed to compare between the standard and HiRes zoom modes in the diagnosis of external root resorption (ERR) using CBCT. MATERIALS AND METHODS: Sixty three small cavities (0.25 mm depth and 0.5 mm diameter) were simulated on the buccal, lingual, and proximal surfaces at three different levels of 16 roots of teeth. After covering the root with nail varnish, the roots were inserted in the sockets and the model was placed in a water-containing lacuna. CBCT scans were taken in both standard and HiRes zoom modes using NewTom VG (QR srl Company, Verona, Italy). Then, an observer assessed the images to determine the presence or absence of the cavities. This process was repeated by increasing the size and depth of cavities to 0.5 mm depth and 1 mm diameter. Data were analyzed by McNemar test. The sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratio in evaluation of the simulated cavities were calculated. RESULTS: There was a significant difference between the two imaging modes in diagnosing the shallow cavities (p=0.02).The sensitivity of the standard zoom in detecting the shallow cavities was lower than that of the HiRes zoom. The likelihood ratio of the HiRes zoom was higher in the diagnosis of both cavity types. CONCLUSION: This study suggested that a smaller voxel size in the HiRes zoom mode of CBCT is preferred for diagnosis of ERR.

Association of persistent hyperglycemia with outcome of severe traumatic brain injury in pediatric population.

PURPOSE: Hyperglycemia is a common secondary insult associated with an increased risk of mortality and poor outcome in traumatic brain injury (TBI), but the effect of hyperglycemia on outcomes of severe TBI in children and adolescents is less apparent. The aim of this study was to evaluate the association of hyperglycemia with mortality in pediatric patients with severe TBI. METHODS: In this cross-sectional study, data of all children and adolescents with severe TBI admitted to Poursina Hospital in Rasht, including age, gender, Glasgow Coma Scale (GCS) upon admission, mortality rate, hospital length of stay, and serial blood glucose during the first three consecutive ICU days following admission, were reviewed from April 2007 to May 2011. After univariate analysis and adjustment for related covariates, logistic regression model was established to determine the association between persistent hyperglycemia and outcome. RESULTS: One-hundred and twenty-two children were included with a median admission GCS of 6 (interquartile range (IQR) 5-7) and a median age of 13 years (IQR 7.75-17). Among them, 91 were boys (74.6%) and 31 were girls (26.6%); the overall mortality was 40.2% (n=49). Patients who died had a significantly greater blood glucose levels than survivors for the first 3 days of admission (P=0.003, P<0.001, P=0.001, respectively). Moreover, persistent hyperglycemia during the first 3 days of admission had an adjusted odds ratio of 11.11 for mortality (P<0.001). CONCLUSION: Early hyperglycemia is associated with poor outcome, and persistent hyperglycemia is a powerful and independent predictor of mortality in children and adolescents with severe TBI.

Febrile seizure: demographic features and causative factors.

OBJECTIVE: Because of geographical and periodical variation, we prompted to determine the demographic features and causative factors for febrile seizure in Rasht. MATERIALS & METHODS: In this cross-sectional study, all 6-month- to 6-year-old children with the diagnosis of febrile seizure admitted to 17 Shahrivar hospital in Rasht, from August, 2009 to August, 2010 were studied. Age, sex, family history of the disease, seizure types, body temperature upon admission and infectious causes of the fever were recorded. All statistical analysis was performed with SPSS software, version 16. RESULTS: Of the 214 children (mean age, 25.24±15.40 months), 124 were boys and 109 had a positive family history. Complex seizures were seen in 39 cases. In patients with a complex febrile seizure, 59% had the repetitive type, 20.5% had the focal type and 20.5% had more than 15 minutes duration of seizures. Most of the repetitive seizures (78.3%) occurred in patients under 2 years old; the difference between under and over 2-year-old patients was statistically significant. Study results did not show significant differences between the two genders for simple or complex seizures. The mean body temperature upon admission was 38.2±1.32◦C (38.31±0.82 degrees in boys and 38.04±1.78 in girls). Upper respiratory infections were seen in most patients (74.29%). All cases of lower respiratory infections were boys. There was a statistically significant difference between boys and girls in causes of fever. CONCLUSION: Most of the children had a positive family history and the most common causative factor was upper respiratory infection.