Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Comparing Different Epinephrine Concentrations for Spinal Anesthesia in Cesarean Section: A Double-Blind Randomized Clinical Trial30230839479ENArashHamzeiDepartment of Anesthesiology and Operation Room, Gonabad University of Medical Sciences, Gonabad, IranSeyed HosseinNazemiDepartment of Anesthesiology and Operation Room, Gonabad University of Medical Sciences, Gonabad, IranAliAlamiSocial Determinants of Health Research Center, Department of Public Health, School of Public Health, Gonabad University of Medical Sciences, Gonabad, Iran0000-0002-8882-3110ArezooDavarinia Motlagh GochanStudent of Critical Care Nursing, Gonabad University of Medical Sciences, Gonabad, IranAzizollahKazemiDepartment of Anesthesiology, 22-Bahman Hospital, Gonabad University of Medical Sciences, Gonabad, IranJournal Article20130814Background: Although various anesthetic techniques can be used in different kinds of surgeries, spinal anesthesia has received considerable attention for the lower abdomen and lower extremities surgeries and cesarean section. This study aimed at comparing the effect of adding epinephrine 1:1000 and 1:10000 to lidocaine and fentanyl in spinal anesthesia on the prolongation of paralysis, analgesia and hemodynamic changes in pregnant women candidate for cesarean section.Methods: A double blind randomized clinical trial was carried out on 66 pregnant women (equally sized control and treatment groups of 33) in 2011. After randomizing the participants into two groups of recipients of epinephrine 1:1000 plus lidocaine 5% and fentanyl (control group) and recipients of epinephrine 1:10000 with lidocaine 5% and fentanyl, (treatment group), the participants' systolic and diastolic blood pressure and heart rate were recorded before and 1, 3, 5, 10, 15 minutes after procedure. Besides the prolongation of paralysis and analgesia, the presence of postoperative nausea and vomiting were evaluated. The outcome of the study was analyzed using SPSS software and via t test, x2 test and RMANOVA.Results: The mean age (standard deviation) of the participants was 29.3(4.4) and 28.2 (4.5) in the treatment and control groups, respectively. There were no statistical significance between the participants' prolongation of paralysis, analgesia, the frequency of nausea and vomiting, and the average values of hemodynamic variables between the two groups.Conclusion: The use of epinephrine 1:10000 along with lidocaine and fentanyl is recommended in spinal anesthesia in pregnant women candidate for cesarean section.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Evaluation of the Effect of Nebulized N-Acetylcysteine on Respiratory Secretions in Mechanically Ventilated Patients: Randomized Clinical Trial30931539482ENSeyed MasoomMasoompourPulmonary and Critical Care Division, Department of Internal Medicine, Shahid Fahghihi Hospital, Shiraz University of Medical Sciences, Shiraz, IranAmirAnushiravaniDepartment of Internal Medicine, Nemazee Hospital, Student Research Center, Shiraz University of Medical Sciences, Shiraz, Iran0000-0002-9196-1901AmirTafaroj NorouzDepartment of Internal Medicine, Nemazee Hospital, Student Research Center, Shiraz University of Medical Sciences, Shiraz, IranJournal Article20150614Background: The purpose of our study was to evaluate an inexpensive and available method to reduce mucous impactions in mechanically ventilated patients.Methods: This randomized clinical trial was conducted on 40 mechanically ventilated patients aged 15-90 years. The patients were randomly allocated into two arms; 20 cases and 20 controls. The cases received N-acetylcysteine via their nebulizers, and the control group received normal saline three times a day for one day. We measured the density of respiratory secretion, plateau and peak airway pressures, and O2 saturation at baseline, 12 and 24 hours later.Results: Although the mean secretion density was significantly lower in the NAC group (F (1, 38)=8.61, P=0.006), but a repeated measures ANOVA with a Greenhouse-Geisser correction determined that the effect of NAC on mean secretion density did not differ significantly between time points (F (1, 38)=3.08, P=0.087). NAC increased O2 saturation significantly between time points (F (1.92, 73.1)=4.6, P=0.014). The plateau airway pressures were relatively stable throughout the study in the normal saline and NAC groups (F (1.95, 37.1)=0.67, P=0.513). The peak airway pressure did not change significantly during the study in the normal saline and NAC groups (F (1.52, 56.4)=0.91, P=0.384).Conclusion: Considering the limitations of the study, nebulized NAC in mechanically ventilated patients was not effective more than normal saline nebulization in reducing the density of mucous plugs. The peak and plateau airway pressures were relatively stable throughout the study in both groups.
Trial Registration Number: IRCT201104276312N1Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Frequency of KIT Mutation in Gastrointestinal Stromal Tumors According to Histologic and Immunohistochemical Findings, the First Report from Iran31632139485ENBitaGeramizadehTransplant Research Center, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranZahraJowkarTransplant Research Center, Department of Pathology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranZeinabRanjbarDepartment of Pathology, School of Medicine,Shiraz University of Medical Sciences, Shiraz, IranJournal Article20130921Background: Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. They are believed to originate from the interstitial cells of Cajal. Most of these tumors contain activating mutations in the KIT receptor tyrosine kinase. This is the first study in Iran to evaluate GISTs at the molecular level.Methods: In the present study, during 5 years (2007-2012), we found 50 cases of GISTs (recurrent or treated cases have been omitted) from the affiliated hospitals of Shiraz University of Medical Sciences. Demographic findings and gross characteristics have been extracted from the clinical charts and pathology reports, respectively. In addition, immunohistochemistry for c-KIT and DOG-1 were performed and reviewed by two pathologists. Molecular study for two common exons of KIT9,11 were performed by PCR and bidirectional DNA sequencing.Results: Among 50 cases of GIST, 17 cases showed wild type KIT and 33 cases (66%) with mutation either in exon 9 or in exon 11. The mutation of exon 9 was detected in 11 (22%) cases, while 29 (58%) cases had mutation of exon 11. In seven cases, both exon 11 and exon 9 mutations were detected at the same time (14%).Conclusion: There is significant variation in the frequency of KIT mutation in exon 9 and 11 from the previous reports. Part of this variation in the previous and current studies is due to methodological differences; however, it seems that ethnic differences should not be underestimated. There are very few studies from the geographic region of Iran; however, the reported cases from the countries such as Turkey are very similar to our findings.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Comparison of Novel Coronary Artery Disease Risk Factors between Obese and Normal Adolescent32232739486ENSamanehKouzehgaranResearch Center and Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranRahimVakiliResearch Center and Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-7707-7052MohsenNematyResearch Center and Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran0000-0000-0000-0000MohamadSafarianResearch Center and Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranMajidGhayour-MobarhanResearch Center and Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iranhttps://orcid.org/00MohamadKhajedalueeResearch Center and Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20150607Background: Coronary artery disease is considered as the most common cause of death in all societies including Iran. This study seeks to compare the new risk factors of coronary-artery diseases in obese adolescents and control group.Methods: In this cross-sectional study, amongst the obese adolescents registered in the nutrition clinic of Ghaem Hospital, 80 individuals were selected. As the control group, additional 80 adolescent students having the same gender and age as the obese group, but with normal weight were selected. These two groups were selected randomly and their serum level of vitamin D, anti-heat shock protein27 (HSP27), balance of oxidants and antioxidants, and homocysteine were determined and compared. Results: In this study, 42 (53.2%) and 37 (46.8%) of the obese and normal weight groups were male, respectively. The mean value of triglyceride, cholesterol, and LDL in the obese group was higher than the normal group, but the mean value for HDL, vitamin D, homocysteine, PAB (Preoxidant and Antioxidants Balance), and anti-HSP27 was not significantly different between the groups. In the base of homocysteine >15 µmol/l, 26.6% of the obese group had hyperhomocysteinemia, therefore homocysteine may be a new risk factor for coronary artery disease in obese adolescents (χ2=4.072; P value=0.091). Conclusion: The findings of this study showed that despite the presence of obesity in adolescence and adolescents, new risk factors are not present among them more than the control group. This was in contrast to what was seen in adults.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701The Effect of Acupressure on Sleep Quality in Menopausal Women: A Randomized Control Trial32833439487ENZahraAbedianEvidence-Based Care Research Centre, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranLeilaEskandariGraduate of Midwifery, Health Center, Semnan University of Medical Science, Semnan, IranHamidAbdiSpecialist of Chinese Traditional Medicine, Dr. Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, IranSaeedEbrahimzadehGraduate Biostatistics, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20130801Background: One of the common problems in menopausal women is sleep disorder. Traditional Chinese acupressure is a noninvasive and safe technique. Menopausal women can easily learn the technique and a self-care method to manage their sleep disorder. This study was carried out to evaluate the effectiveness of acupressure on sleep quality of postmenopausal women in Mashhad during 2009.Methods: This double blind, randomized clinical trial was performed on 120 qualified menopausal women at the age of 41-65 years. Their sleep quality was measured according to the Pittsburgh Sleep Quality Index (PSQI). Participants were randomly assigned to an acupressure group (n=37), a sham acupressure group (n=36) and a control group (n=32) by two time randomized method (systematic and simple randomized). These interventions were carried out for four consecutive weeks. The participants in the acupressure and sham acupressure groups learned to carry out the acupressure technique as a self-care at home with simultaneous massage techniques that were to be performed 2 hours before sleep, whereas only conversation was used in the control group. The data were analyzed by the SPSS software version 17.Results: The results indicated significant differences in total PSQI scores among the three groups (P<0.001). Tukey’s test revealed that there were significant differences between the acupressure group and the control group (P<0.001), the acupressure group and sham acupressure group (P<0.001), and the sham acupressure and the control group (P<0.001).Conclusion: Acupressure can be used as a complementary treatment to relieve sleep disorders in menopausal women; and is offered as an efficient method to manage sleep quality.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Hand Grip Strength and Myocardial Oxygen Consumption Index among Coronary Artery Bypass Grafting Patients33534039488ENSiti Nur Baait Biniti MohdSokranDepartment of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, Malaysia; and KPJ Damansara Specialist Hospital, Damansara Utama, Petaling Jaya, Selangor, MalaysiaVikramMohanDepartment of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, MalaysiaKamariaKamaruddinDepartment of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, MalaysiaMohd DaudSulaimanKPJ Damansara Specialist Hospital, Damansara Utama, Petaling Jaya, Selangor, MalaysiaYahyaAwangKPJ Damansara Specialist Hospital, Damansara Utama, Petaling Jaya, Selangor, MalaysiaIda Rosmini BintiOthmanCenter for Statistical Studies, Faculty of Computer and Mathematical Sciences, Universiti Teknologi MARA, Shah Alam, Selangor, MalaysiaSmiley Jesu PriyaVictorDepartment of Occupational Therapy, Faculty of Health Sciences, Universiti Teknologi MARA, Puncak Alam, Selangor, MalaysiaJournal Article20150607Background: Hand grip strength (HGS) is a reliable indicator of peripheral muscle strength. Although, numerous studies have investigated the strength of hand grip; little attention has been given to coronary artery disease (CAD) patients, exploring the relationship between HGS and myocardial oxygen consumption (MVO2) index. The current study aimed to evaluate the interaction between HGS and MVO2 index findings before and after cardiac surgery. Methods: Twenty-seven patients with CAD had HGS were assessed using handheld dynamometer. HGS for each hand were documented. MVO2 index was assessed using rate pressure product (RPP), which is the product of the heart rate (HR) and systolic blood pressure (SBP). Repeated measures MANOVA were carried out to estimate the interaction between both hands HGS and MVO2 index before and after surgery.Results: There was significant interactions (P<0.001) for both HGS dominant and non-dominant with large effect sizes (HGS dominant×MVO2 index: hp2=0.44; HGS dominant×RPP: hp2=0.49). This signifies that peripheral muscle strength of the upper limb (HGS dominant and non-dominant) had different effects on MVO2 index before and after surgery. The interaction graph shows that the increase in MVO2 index after surgery was significantly greater for peripheral muscle strength of the dominant hand when compared to non-dominant. Conclusion: Patients with CAD had interactions between HGS and oxygen consumption before and after surgery. Hence, HGS might be used as a predictor to assess oxygen consumption among cardiac patients.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Lipid Profiles and Prevalence of Dyslipidemia in Eastern Iranian Adolescents, Birjand, 201234134839489ENFatemehTaheriBirjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IranTayebehChahkandiBirjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IranTobaKazemiBirjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IranBitaBijariBirjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IranMahmoudZardastBirjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran00989151615385KokabNamakinBirjand Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, IranJournal Article20150614Background: Cardiovascular risk factors begin in childhood and adolescence. This study aimed at assessing serum lipids and prevalence of Dyslipidemia in 11-18 year old students of Birjand.Method: The present cross-sectional, descriptive, and analytical study was done on 2,643 middle and high school students of Birjand aged 11-18 years (1,396 girls and 1,247 boys). Blood samples were collected for the measurement of blood lipids, including Cholesterol, Triglyceride, HDL, and LDL after a 12-hour fasting period. The defined borderline and abnormal values stated in 2011 by the American Academy of Child, was used.Results: According to our results, it is concluded that: (i) 34.3% (31.3% girls and 37.6% boys) of adolescents had at least one dyslipidemia. (ii) 24.7% of the individuals had HDL lower than 40, where 14% of them TG≥130, 6.1% of cases TC≥200, and 3.5% of cases LDL≥130. Lipid disorder within low HDL type and hypertriglyceridemia were significantly higher in boys (P<0.05) than girls. Hypercholesterolemia and hypertriglyceridemia in the age group of 11-14 years and low HDL in the age group of 15-18 years showed the highest values (P<0.05).Conclusion: Adolescents of Birjand have high prevalence of dyslipidemia. Preventive measures are recommended to improve lifestyle, including healthy nutrition, encouraging adolescents to exercise, and more mobility.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Psychometric Properties of the Patient Self-Advocacy Scale: The Persian Version34935539490ENShaghayeghVahdatDepartment of Health Service Administration, Fars Science and Research Branch, Islamic Azad University, Marvdasht, Iran; and Department of Health Service Administration, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran0000-0002-2805-8955LeilaHamzehgardeshiDepartment of Health Service Administration, Fars Science and Research Branch, Islamic Azad University, Marvdasht, Iran; and Department of Health Service Administration, Marvdasht Branch, Islamic Azad University, Marvdasht, Iran; and Public Health Center, Mazandaran University of Medical Sciences, Sari, IranZeinabHamzehgardeshiDepartment of Reproductive Health and Midwifery, Nasibeh Nursing and Midwifery Faculty, Mazandaran University of Medical Sciences, Sari, Iran; and Traditional and Complementary Medicine Research Centre, Mazandaran University of Medical Sciences, Sari, Iran0000-0002-4150-0576SomayehHessamDepartment of Health Services Administration, Shiraz Branch, Islamic Azad University, Shiraz, Iran0000-0001-6501-3687Journal Article20130814Background: Advances in science and technology and the changes in lifestyle have changed the concept of health in terms of etiology and mortality. The aim of this study was to test the psychometric properties of the original Patient Self-Advocacy Scale for use with an Iranian population.Methods: In the current study, 50 chronic patients between the ages of 25 and 75 were selected as samples. This study was conducted in May 2013 at Bou Ali Sina Hospital in Sari. The translation process and cultural adaptation of the Patient Self-Advocacy Scale were conducted. The face validity and content validity of the instrument were formally verified by analyzing the feedback of patients and health professionals. In order to evaluate questionnaire’s reliability, the intraclass correlation coefficient (ICC) was calculated for each item and each domain; and the Cronbach’s alpha was calculated for the entire instruments and each domain.Results: Of the 50 patients participating in the study, 36% were male and 64% were female. The mean age of the patients was 42.5. To comply with the Iranian culture and the study target population, slight changes were applied to the process of translation and validation. In the present study, intraclass correlation coefficient for each item was 0.8-1, which demonstrates excellent reliability of the questionnaire. The Cronbach’s alpha value was 0.75 for overall scale.Conclusion: The Persian version of Patient Self-Advocacy Scale was valid and reliable. Hence, it can be used by public health researchers and health system policy makers for programming and offering patient-oriented health services based on patients’ comments, needs, and preferences.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Distribution of Health Resource Allocation in the Fars Province Using the Scalogram Analysis Technique in 201135636139477ENNahidHatamSchool of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran0000-0001-7738-1970ShahnazKafashiSchool of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, IranZahraKavosiSchool of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, IranJournal Article20150614The importance of health indicators in the recent years has created challenges in resource allocation. Balanced and fair distribution of health resources is one of the main principles in achieving equity. The goal of this cross-sectional descriptive study, conducted in 2010, was to classify health structural indicators in the Fars province using the scalogram technique. Health structural indicators were selected and classified in three categories; namely institutional, human resources, and rural health. The data were obtained from the statistical yearbook of Iran and was analyzed according to the scalogram technique. The distribution map of the Fars province was drawn using ArcGIS (geographic information system). The results showed an interesting health structural indicator map across the province. Our findings revealed that the city of Mohr with 85 and Zarindasht with 36 had the highest and the lowest scores, respectively. This information is valuable to provincial health policymakers to plan appropriately based on factual data and minimize chaos in allocating health resources. Based on such data and reflecting on the local needs, one could develop equity based resource allocation policies and prevent inequality. It is concluded that, as top priority, the provincial policymakers should place dedicated deprivation programs for Farashband, Eghlid and Zaindasht regions. Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Epidemiology of Vasculitides in Khorasan Province, Iran36236639480ENMohammadhassanJokarDepartment of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IranZahraMirfeiziDepartment of Internal Medicine, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20131230Vasculitides are a heterogeneous group of more than 20 diseases defined by inflammation and destruction of blood vessels. We aimed to study the demographic characteristics of the primary vasculitides in the North East of Iran. We retrospectively studied the medical records of patients diagnosed with any kind of vasculitis at the Clinic and Department of Rheumatology of the Imam Reza Hospital, Mashhad, Iran between January 1, 2002, and December 31, 2012. Patients were classified according to the American College of Rheumatology 1990 criteria for the classification of vasculitis and the 2012 Revised International Chapel Hill Consensus Conference Nomenclature of Vasculitides. A total of 721 patients (51.5% male, 48.5% female) with a diagnosis of primary vasculitis was identified. The frequency distributions of vasculitic disorders were as follows: Behcet’s disease, 63.6%; cutaneous leukocytoclastic angiitis, 8.2%; granulomatosis with polyangiitis (Wegener’s), 6.8%; Takayasu’s arteritis. 6%; giant cell arteritis, 4%; polyarteritis nodosa, 2.1%; microscopic polyangiitis, 0.6%; eosinophilic granulomatosis with polyangiitis (Churg-Strauss), 1.8%; cryoglobulinemic vasculitis, 0.3%; and IgA vasculitis (Henoch-Schonlein purpura), 3.5%. In our population, the most common forms of vasculitis are Behcet’s disease, cutaneous leukocytoclastic angiitis, and granulomatosis with polyangiitis (Wegener’s).Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Foramen Tympanicum or Foramen of Huschke: A Bioarchaeological Study on Human Skeletons from an Iron Age Cemetery at Tabriz Kabud Mosque Zone36737139483ENJafarRezaianDepartment of Anatomical Sciences, School of Medicine, Lorestan University of Medical Sciences, Khoramabad, IranMohammad RezaNamavarDepartment of Anatomical Sciences, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran; and Histomorphometry and Stereology Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, IranHamedVahdati NasabDepartment of Archeology, Faculty of Humanities, Tarbiat Modares University, Tehran, IranAli RezaHojabri NobariDepartment of Archeology, Faculty of Humanities, Tarbiat Modares University, Tehran, IranAliAbedollahiDepartment of Anatomical Sciences, School of Medicine, Tabriz University of Medical Sciences, Tabriz, IranJournal Article20131225The foramen tympanicum is an anatomical variation that is created in the tympanic plate of temporal bone during the first year of life. The tympanic plate grows and foramen tympanicum is gradually closed by about the fifth postnatal year. However, due to a defect in normal ossification, foramen tympanicum sporadically remains throughout life. The construction of a shopping center in Tabriz, northwest of Iran, led to the discovery of an Iron Age cemetery (1500-500 BC). Several tombs have been uncovered below one meter of sterile soil so far and a thick level of architectural debris from the medieval city has been discovered. Up to now, no bioarchaeological data has been gathered about the burials in this area. Thus, the present study aimed to evaluate the prevalence of foramen tympanicum in this area. In this study, 45 skeletons were studied and the prevalence of this foramen was about 4.4% bilaterally. We also reported on two babies with fused and un-fused squamotympanic fissure. The persistence of this foramen is a possible risk factor for otologic complications after arthroscopy of the temporomandibular joint and salivary gland fistula through this foramen. The closure of this foramen could be also used for age estimation in sub-adult individuals. The incidence of this trait in this study was similar to other available studies on modern skeletons.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Refractory Angioedema in a Patient with Systemic Lupus Erythematosus37237539478ENZahraHabibagahi1Department of Rheumatology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; and Department of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IranJamshidRuzbehDepartment of Nephrology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran; and Department of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IranVahideYarmohammadiDepartment of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IranMaliheKamaliDepartment of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IranMohammad HassanRastegarDepartment of Internal Medicine, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, IranJournal Article20150614Angioedema secondary to C1 inhibitor deficiency has been rarely reported to be associated with systemic lupus erythematosus. A genetic defect of C1 inhibitor produces hereditary angioedema, which is usually presented with cutaneous painless edema, but edema of the genital area, gastrointestinal and laryngeal tracts have also been reported.In lupus patients, angioedema may be the result of an acquired type of C1 inhibitor deficiency, most probably due to antibody formation directed against the C1 inhibitor molecule. Herein we report a new case of lupus nephritis that developed angioedema and a rapid course of disease progression with acute renal failure and alveolar hemorrhage without response to high dose steroid and plasmapheresis. Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Bilateral Staged Total Hip Replacement and the Natural Progress of an Untreated Case of Developmental Dysplasia (Dislocation) of the Hip: A Clinical Case Report by the Surgeon and the Patient37638039481ENHamidHonarpishehIranian Medical Science Councils Secretariat, Deputy of Education, Ministry of Health and Medical Education, Tehran, IranMohammad TaghiGhazaviOrthopedic Surgery, Shafa Orthopedic Hospital, Iran University of Medical Science, Tehran, IranJournal Article20150607The natural history of an untreated case of a Developmental Dysplasia (Dislocation) of the Hip (DDH) associated with multiple congenital abnormalities is reported in a 55-years-old man. The patient’s complaints and the varieties of the typical manifestations emerged in other parts of the body throughout the life are reviewed and discussed as comorbidities of a dysplastic condition. Two-stage bilateral total hip replacement (THR) operations were performed at the age of 55. In addition, to relieve the pain, the walking disabilities were overcome, hence gaining normal walking in swing and stances. The leg length discrepancy was corrected by anatomically positioned prostheses, examined by the knee bending test and characterized and evidenced by radiological features and indices.Shiraz University of Medical SciencesIranian Journal of Medical Sciences0253-071640420150701Pyoderma Vegetans: A Case Report in a Child Suspected to Primary Immunodeficiency and Review of the Literature38138539484ENMahboubehMansouriDepartment of Immunology and Allergy, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran0000-0001-5635-122xAzadehRakhshanDepartement of Pathology, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Science,
Tehran, IranMohammadShahidi-DadrasSkin Research Center, Shohada-e-Tajrish Hospital, Shahid Beheshti University of Medical Science,
Tehran, IranAbdollahKarimiDepartment of Pediatric Infectious Diseases, Mofid Children Hospital, Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IranSaminAlaviPediatric Congenital Hematologic Disorders Research Center, Mofid Children Hospital, Shahid Beheshti University of Medical Sciences,
Tehran, IranJournal Article20150607Pyoderma vegetans (PV) is a rare inflammatory disorder characterized by vegetating pustules and plaques affecting the skin and mucosal membranes. It is believed that this entity is mostly associated with inflammatory bowel disease (IBD), chronic malnutrition, human immunodeficiency virus (HIV), malignancies, and other immunocompromised states. Pyoderma vegetans occurs more commonly in young and middle-aged adults. There is no sex predilection for this entity. The lesions could heal spontaneously, but usually recur and become chronic.Our patient was an 11-year-old girl suspected to have primary combined immunodeficiency complicated by chronic recurrent vegetating pustular lesions on the face and postauricular area since one year of age. The histological features of the lesions were consistent with pyoderma vegetans. This is the first case of PV beginning from early infancy in the setting of primary immunodeficiency and in an unusual location.