مجله دانشکده پزشکی اصفهان
پیاپی 443 (هفته سوم مهر 1396)

Acute renal failure is one of the problems among hospitalized patients in different parts of the hospital, which, if not considered, will increase patient costs, length of hospitalization, and mortality rate; identification of factors affecting it will reduce these complications. Therefore, the aim of this study was to compare the relationship between preoperative hemoglobin level and acute renal failure in patients undergoing noncardiac surgery.
This study was performed on 440 patients with noncardiac surgery. Patients were divided into four groups of 110 based on the level of hemoglobin and the need for blood transfusion. Then, the incidence of acute renal failure after the surgery and laboratory and demographic variables were determined and recorded in four groups. Chi-square and one-way ANOVA tests were used to compare studied variables.
Findings: The lowest frequency of acute renal failure was found in the group of normal hemoglobin and no need for blood transfusion (3.6%); and the highest frequency was related to the group of abnormal hemoglobin and needing blood transfusion (54.5%) (P Our study revealed that patients with abnormal hemoglobin and needing blood transfusion have the highest risk for acute renal failure after the surgery. So that, the creatinine increased significantly in these patients and, on the other hand, urinary excretion reduced significantly.

Cyclooxygenases-2(COX) expression in cancer tissues is associated with worse prognosis of cancers. We studied cyclooxigenase-2 expression among patients with head and neck squamous cell carcinoma (HNSCC).
In a cross-sectional study performed in two university hospitals in Isfahan City, Iran, between the years 2011 and 2015, patients with newly pathological diagnosis of HNSCC were evaluated. Real-time polymerase chain reaction (real-time PCR) was used to evaluate the expression of cyclooxigenase-2 in surgical excised cancer tissues. Patients were followed-up for one year regarding recurrence and mortality. Association of cyclooxigenase-2 expression with clinicopathologic data and prognosis were analyzed.
Findings: Thirty cases of HNSCC with mean age of 59.6 years (70% men) were studied. Only 4 cases (13.3%) were cyclooxigenase-2 positive. Compared with cyclooxigenase-2 negative cases, those with cyclooxigenase-2 expression were relatively, but not significantly, older (71.0 ± 12.5 vs. 57.8±12.0 years, P = 0.054) and had larger tumor size (2.70 ± 1.19 vs. 1.76 ± 0.84 cm, P = 0.061), more frequent moderately/poorly differentiated tumors (50.0 vs. 15.3 percent, P = 0.190), and more frequent involvement of the lymph nodes (50.0 vs. 7.6 percent, P = 0.075). One of the cyclooxigenase-2 positive cases had metastasis. After one year follow-up, recurrence rate was 75.0% and 9.5% in cyclooxigenase-2 positive and negative cases, respectively (P = 0.005).
We found that cyclooxigenase-2 expression in HNSCC patients is associated with worse clinicopathologic characteristics and prognosis. It may be used as a prognostic factor for HNSCC and also a target for treatment. Further studies with larger sample size are warranted in this regard.

Coronary artery disease is the most important cause of death due to cardiovascular diseases and the main treatment is angioplasty. The purpose of this study was to evaluate the results of angioplasty in patients based on angiographic results, SYNTAX score, clinical conditions, cardiovascular risk factors and non-invasive tests. Additionally, the matching of angioplasty procedure with clinical guidelines was investigated.
This was a cross-sectional study on 2297 patients referred to cardiac centers in Isfahan City (Chamran, Sina, Sepahan, Saadi, and Shahid Sadughi), Iran, for angioplasty during the second half of the year 2015. Demographic data, history of diabetes, hypertension, or hyperlipidemia, family history of heart disease, and current use of cigarettes were recorded. The extension of coronary artery disease was assessed using SYNTAX score.
Findings: Among 2297 patients, 1577 (69.1%) were men and 706 (30.9%) were women. In 87% of patients, angioplasty was performed according to the guideline; and in 13% of them, open heart surgery or medical treatment was appropriate treatment instead of angioplasty. Significant correlation between the extent of coronary artery disease and the risk factors as age, diabetes, and hyperlipidemia was observed based on SYNTAX score system.
In patients undergoing coronary angiography, SYNTAX score has an acceptable value in association with heart risk factors to demonstrate the generalizability of this association. A prospective cohort study can be used as a way to risk assessment for the patients and selection of appropriate diagnostic or medical strategy.

Considering the effects of Botox, the present study aimed to determine the effect of Botox injection in survival of skin flap in rabbits. If positive effect, we can help to increase skin flap survival.
In an experimental study, 6 New-Zealand rabbits were selected and each rabbit was used for two separate skin flap surgeries. Initially, two flaps were designed for each rabbit and 12 units of Botox were injected into one of them. During the first week after the Botox injection, flap was removed and sutured again. Skin necrosis was clinically studied at one and three weeks after flap removing and three weeks after flap removing in laboratory methods.
Findings: One week after the intervention, the average necrotic areas were 5.00 ± 1.79 and 13.33 ± 2.07 cm2 in the experimental and control groups, respectively (P Injection of Botox in the rabbit flaps leads to decrease of skin necrosis and increase of vascular density; probably, Botox injection can increase flaps survival.

All natural anticancer agents are cytotoxic basically and act mainly by the inhibition cell proliferation; but they have different mechanisms. Two assays, thiazolyl blue [3- (4, 5-dimethylthiazol-2-yl) -2, 5-diphenyl-terazoliumbromide or MTT] and sulforhodamine B (SRB), are used to assess cell growth. This study aimed to compare measurements between MTT and SRB on the cancer cell lines.
Different concentrations of the bromelain were added to cultured cells including mouse breast cancer (4T1), human gastric carcinoma (AGS), and human prostate carcinoma (PC3) cell lines and incubated at 24 and 48 hours. The growth and proliferation rates of the studied cells were investigated using both MTT and SRB assays after treatment with bromelain. The differences between cells were determined using Kruskal-Wallis and Dunns tests.
Findings: Bromelain significantly decreased growth and proliferation rate of 4T1, AGS and PC3 cancer cells, in a concentration-dependent manner at different times, in both MTT and SRB assays.
Findings showed that both MTT and SRB assays gained similar data regardless of the cell types.

Resistance to beta-lactams is the most important feature in Staphylococcus aureus (S. aureus). There is a possibility that the amount of resistance and beta-lactam antibiotic resistance gene expression are different in Staphylococcus resistant strains. The aim of this study was to determine the expression of mecA and blaZ genes in methicillin-resistant S. aureus and the relationship between gene expression patters.
In this experimental-analysis study, 120 clinical isolates of methicillin-resistant S. aureus were isolated from different clinical samples using phenotypic tests. To study the quality of the mecA and blaZ genes in resistant isolates, polymerase chain reaction (PCR) was used. In addition, the quantity of genes, SYBR-Green-1-based real-time PCR was applied. REST 2008 and SPSS software were used to analyze the data.
Findings: Out of 120 isolates of methicillin-resistant S. aureus, 105 isolates (87.5%) had blaZ gene. The most diverse gene expression changes in sample type were seen in blood and urine samples. So, the expression on the wound and urine clinical samples was dramatically more than the other sites. In addition, significant relationship was observed between the blaZ and mecA gene expression and the kind of clinical samples.
The results of this study suggested that different doses of antibiotics should be used to treat staphylococcal infections in different organs.

The blood pressure has not been controlled in most of patients due to inappropriate treatment; and they suffer from the complications. To solve the problem, training through short message service (SMS) will be applied and this article is a report of designing the SMS-training approach for patients with hypertension. The current intervention is a randomized clinical trial implemented on patients with hypertension in Gorgab Center (Shahin-Shahr and Meyme town) subordinate to Isfahan University of Medical Sciences, Iran. Firstly, 110 patients will be chosen from the list of patients with hypertension using simple randomized method. Afterwards, the patients will be assigned in one of the intervention or control groups randomly by using random numbered table. Before intervention, all the patients will fill the compliance questionnaire and then, their blood pressures will be measured by caregivers. Patients in SMS group will be texting daily for one month containing a training text to motivate them to improve their life style and use medicine properly. Finally, after one and two months, blood pressure will be measured for all the patients again and the treatment adherence questionnaire will be filled. SMS can be applied as a training method to control hypertension.