مجله دانشکده پزشکی اصفهان
پیاپی 477 (هفته اول تیر 1397)

The postoperative pain is a common problem after vitrectomy. Sufentanil and fentanyl are two highly effective opioid analgesics. In this study, we assessed the effect of these two drugs on reducing pain and hemodynamic changes in patients after deep vitrectomy.
This double-blinded randomized clinical trial study was performed on 70 patients undergoing vitrectomy. Patients were divided into two groups receiving intravenous fentanyl (2 μg/kg) or sufentanil (0.2 μg/kg). The drugs were administrated before induction of anesthesia, and 15 minutes before the ending of surgery. The data of this study were compared in two groups.
Findings: The mean postoperative pain intensity (VAS) in the sufentanil group was significantly lower than the fentanyl group at the time of entering the recovery (P = 0.001), immediately before exiting of recovery (P Fentanyl and sufentanil are effective in reducing postoperative pain, and have similar results. The analgesic effect of sufentanil is more pronounced in the early hours after the surgery.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory, demyelinating, multifocal disease primarily involves the white matter of the central nervous system. The most common symptoms are fever, headache, and nausea progressing to encephalopathy and coma. The purpose of this study was to evaluate neurological outcomes in pediatrics patients with acute disseminated encephalomyelitis.
In this prospective study, we evaluated all pediatric patients with acute disseminated encephalomyelitis admitted in the service of pediatrics neurology in Imam Hussein pediatrics hospital, Isfahan, Iran, during the Years 2011-2017. The patients were diagnosed based on clinical and magnetic resonance imaging (MRI) findings.
Findings: The most common symptoms included fever, headache, drowsiness, dizziness, and nausea. The most frequent findings in magnetic resonance imaging were T2 signal changes in basal ganglia, periventricular regions, and centrum semiovale and cerebellum. Of 21 patients enrolled in this study, 14 had full recovery, 1 had right hemiparesis, 1 had left hemiparesis with dysphagia, 1 suffered from delayed speech, cognition, and motor growth, 1 suffered from seizure, 1 had hemidystonia; 1 patient suffered from visual impairment and seizure, and 1 patient expired.
In patients with encephalopathy, considering high level of suspicion of acute disseminated encephalomyelitis, and performing early imaging assessments will help initiate therapy and better prognosis.

Ionizing radiation used in computed tomography (CT) has a carcinogenic risk. The aim of this study was to evaluate the justification of CT scan requests by physicians in Kashani hospital, Isfahan, Iran.
Patient's data including the gender, age, type of CT scan, the cause of the request, the specialty of the requesting physician, and the test report were collected. The percentage of positive or abnormal cases for each test was obtained based on radiologist reports. The percentage of positive cases was also determined in term of the specialty of the requesting physicians.
Findings: The data of 888 patients were analyzed. The number of CT scans of the brain, abdomen, chest, spine, facial bones, pelvis, upper limbs, and lower limbs was 601, 13, 31, 76, 53, 29, 19, and 66, respectively. The lowest and highest percentages of positive results were related to brain (18.64%) and upper extremity (36.84%) CT scan, respectively. The highest percentage of normal results was related to patients referred to the CT scan by general practitioners, general surgeons, and emergency medicine specialists.
Totally, in all tests, 78.38% of the reports were normal, and less than 22% of the tests were indicative of pathological cases. Therefore, it is necessary to reduce the requests without indication to reduce the radiation dose of the community. The knowledge of the physicians about the suitable justification of the CT scan tests should be increased based on clinical guidelines, as well.

Long non-coding RNAs (LncRNAs) are a class of RNA molecules with 200-10000 nucleotides in length that have lost their protein coding capacity. They play important role in numerous biological processes including cell proliferation, differentiation, apoptosis, and cancer development. Acute myeloid leukemia (AML) is the most common leukemia. Evidence has shown that long non-coding RNAs PVT1 is upregulated in acute myeloid leukemia, and leads to an increase in cell proliferation. This study aimed to assess the effect of long non-coding RNA PVT1 inhibition by antisense LNA GapmeRs technology on proliferation of human acute erythroleukemia cells.
Human acute erythroleukemia cells (KG1), known as subgroup six of acute myeloid leukemia based on the French–American–British (FAB) classification, were cultured in Roswell Park Memorial Institute (RPMI) medium. Long non-coding RNA PVT1 degradation was performed using antisense LNA GapmeRs technology. At different time points after transfection (24, 48, and 72 hours), long non-coding RNA PVT1 expression and cell proliferation were assessed. Reverse transcription-quantitative polymerase chain reaction (RT-qPCR) was accomplished to evaluate the long non-coding RNAPVT1 expression. Moreover, Cell viability was measured using 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide (MTT) assay.
Findings: Long non-coding RNA PVT1 expression decreased at 24, 48, and 72 hours after transfection in the antisense LNA GapmeRs group compared to control groups. Cell viability and proliferation was significantly decreased in antisense LNA GapmeRs transfected group compared with other two groups.
The present survey exhibited that inhibition of long non-coding PVT1 by using antisense LNA GapmeRs can dramatically reduce the proliferation of human acute erythroleukemia cells. Our results can be helpful in translational medicine for antisense therapy in acute myeloid leukemia.

Menopause is a major concern in women’s productivity. Low estrogen in this period brings about many complications. Besides hot flashes, which are the most common menopausal symptom, women might experience vaginal dryness, sleeping disorders, depression, low bone density, as well as cardiovascular diseases. To decrease these life-threatening complications, postmenopausal women receive varying treatments including hormone replacement therapy (HRT). Among the replacement therapies, phytoestrogens are special. The present study was conducted to investigate the effect of phytoestrogens on menopause symptoms.
This was a systematic review of the previous studies. The search was conducted through Science Direct, Scopus, PubMed, EMBASE, Google Scholar, Scientific Information Database (SID) and IranMedex databases during 2013-2017, using the keywords menopause, climacteric, phytoestrogens, isoflavones, non-steroidal estrogen, and menopausal symptoms.
Findings: Ultimately, 25 articles, including 7 meta-analyses, 14 clinical trials, 2 cohort studies, and 2 cross-sectional ones were found focusing on the effect of phytoestrogens on menopause symptoms. These studies measured the effect of phytoestrogens on depression, vaginite atrofica, hot flashes, cardiovascular diseases indices and blood pressure, bone status, and the risk of cancer in women.
The results revealed that having estrogenic effects, the phytoestrogens could be considered as a proposed treatment to relieve menopause symptoms in the hope of improving women’s quality of life during this time span.