مجله دانشکده پزشکی اصفهان
پیاپی 383 (هفته سوم تیر 1395)

Delirium is a dangerous neuro-psychiatric syndrome. Intensive Care Delirium Screening Checklist (ICDSC) is a suitable tool for diagnosis of this disease. This tool has not been translated and validated into Persian language until now. The goal of this study was to determine the reliability and validity of Persian version of this tool in detection of delirium in intensive care units (ICU).
This study is a psychometric study of the Persian version. All samples were selected from hospitalized patients in ICU and nurses in Al-Zahra hospital, Isfahan, Iran, in 2015. In each case, after 30 minutes of making diagnoses based on Diagnostic and Statistical Manual of Mental Disorders-Forth Version-Text Revision (DSM-IV-TR) criteria by a psychiatrist, a nurse makes her diagnoses by using ICDSC without knowing the psychiatrist’ idea. Then all cases of delirium diagnosis according to the tool were compared with delirium diagnosis by psychiatrist and psychometric properties of tool were assessed.
Findings: After doing forward and backward translation, the face validity was confirmed. The mean of content validity index (CVI) in relevancy, clarity and simplicity were 0.83, 0.81, and 0.86 respectively. The construct validity based on factor analysis outputs were above 0.5 for all items. In criterion validity measurement, the cut point of five for Persian version of ICDSC is founded. In this cut point the sensitivity and specificity of the tool was calculated 80% and 93%, respectively. The positive predictive value and negative predictive value in this cut off was calculated 92% and 88%, respectively. The correlation between an equivalent criteria with this tool for delirium screening was 0.74 (P = 0.001). Internal Consistency for the tool based on Cronbach’s alpha was 0.83 and the correlation between two split half of the tool for delirium screening was 0.72.
The Persian version of ICDSC has a high validity and reliability for delirium screening. This tool in cut point of five can differentiate delirium from normal case with high positive and negative predictive value.

Electrons have an advantage of steep dose fall-off after R80. The unique curved geometry of the chest-wall and the special isodose shapes of electrons make complexities to chest-wall electron therapy. Bolus material has been applied to electron fields for shaping the coverage of planned volume and compensating for surface irregularities. Electron bolus conformal therapy methods are not yet vastly available; therefore, this study tries to extrapolate suggestions for conventional usage of bolus and different electron beam energies.
Computer plans for 10 post-mastectomy patients with at least 1cm elevated or depressed surgical defects were designed. Bolus thicknesses of 5, 10, and 15 mm and electron energies of 9, 12, 15, and 18 MeV were applied to the clinical target volume. Average doses to the surface, clinical target volume (CTV1), ipsilateral lung and heart were calculated by the planning system and then analyzed.
Findings: High energies of electrons and thicker bolus reduced the risk of CTV1 underdose. Bolus increases surface dose whereas decreases mean dose to CTV. Nine MeV electrons and bolus was unsuitable for this type of treatment. In most treatments the dose increase to lung was statistically significant (P Careful design of bolus thickness is important when planning with lower energy electrons. This study suggests that planning with thicker bolus material and higher energy selection has advantage of dose conformity with conventional methods of electron therapy in a defected surface.

Common variable immune deficiency (CVID) is the commonest symptomatic primary immunodeficiency and represents a heterogenous collection of disorders resulting mostly in antibody deficiency and recurrent infections .The syndrome includes impaired B-cell maturation, impaired somatic hypermutation, reduced numbers of circulating memory and isotype-switched memory B cells, and absent or reduced plasma cells. B cell maturation antigen (BCMA) is a tumor necrosis family receptor superfamily member 17 (TNFRSF17), expressed only on B cell lines , and is essential for survival of long-lived plasma cells .The aim of this study was to evaluate mutations in BCMA in patients with CVID in compare with normal individuals in Isfahan, Iran.
Blood samples were collected from 10 CVID patients with substitutive immunoglobulin therapy before immunoglobulins (Ig) infusion and 10 normal controls in ethylenediaminetetraacetic acid (EDTA) tubes then DNA samples were extracted and after the polymerase chain reaction (PCR) was done, samples were sequenced.
Findings: After reviewing the results of the sequence and alignment of the sequences, no mutations in the gene were seen.
In addition to the study of mutation in BCMA gene, BCMA gene and protein expression level should be considered to understand more aspects of this disease.

The metabolic syndrome includes several metabolic disorders and its incidence is increasing among diabetic patients. Types of dietary fats have been related to components of the metabolic syndrome. So this study aimed to investigate the association between dietary fatty acids with metabolic syndrome indices in patients with type 2 diabetes.
This cross-sectional study was conducted on 300 patients with type 2 diabetes. Dietary intake was assessed using a validated Food Frequency Questionnaire. Nutritionist 4 Software was employed for analysis of dietary variables and SPSS software was used for statistical analysis.
Findings: 69.6% 0f patients were diagnosed with metabolic syndrome. After adjustment of the confounder factors a significant negative correlation was observed between omega3 with systole blood pressure (P = 0.01) and diastole blood pressure (P = 0.002). Also significant positive correlation was observed between mono unsaturated fatty acids with fasting blood sugar (P = 0. 006) and omega3 with triglyceride (P = 0.01).
According to the study, omega3 fatty acids are associated with a lower blood pressure in people with type 2 diabetes. Also, we observed positive correlation between mono unsaturated fatty acids with fasting blood sugar and omega3 with triglyceride. But, further prospective investigations are needed to confirm our results.

Stem cells are the main component in cell-based therapies and regenerative medicine to replace damaged tissues and cure various diseases. In regenerative medicine, in vitro stem cells’ culture is required for proliferation and differentiation. Although the risk of using these cells has not been established; but in addition to the possibility of spontaneous differentiation of undifferentiated cells after transplantation and teratoma formation, genome of these cells in culture media is instable and can be changed. Genomic instability can affect the transplantation safety of these cells or tissues derived from them. Genomic instability is one of the common features in stem cells and cancer. Hence, there is concern that the genomic instability during the manipulation of stem cells can be tumorigenic. Genomic instabilities are included in different sizes from point mutation to aneuploidy and mosaicism. Types of stem cells, culture conditions and some manipulation of cells such a long time are effective in creation and the rate of these instabilities. Therefore, in addition to optimizing the time and culture conditions, it is recommended to examine and follow the genomic abnormalities before therapeutic uses with appropriate methods.