مجله دانشکده پزشکی اصفهان
پیاپی 361 (هفته اول بهمن ماه 1394)

Leukemia makes up about 8% of all cancers. Understanding the epidemiology of leukemia is very effective in planning for this cancer. According to lack of information in the field, the present study aimed to investigate the epidemiology and trend of incidence of leukemia in Iran during 2003 to 2010. This cross-sectional study was conducted using the analysis data from the Iranian National Cancer Registration System and Disease Management Center, Ministry of Health and Medical Education during the years 2003 to 2010. The incidence rates were calculated by age and gender and the trend of incidence of the disease by sex during this period was achieved. Evaluation of cancer registration data in the years 2003 to 2010 showed the ascending trend of leukemia in Iran. 21814 cases of leukemia were recorded in the whole country that increased from 1734 cases in 2003 to 3461 cases in 2010. The highest and the lowest incidence in women and men were reported in years 2009 and 2003, respectively. In the provinces of country, the highest reported incidence in women was in Yazd and the lowest incidence was in Semnan, Kermanshah, Qom and Kohgiluyeh and Boyer Ahmad; and for men, the highest incidence was in Yazd and the lowest incidence was in Zanjan, North and South Khorasan, Semnan, Ardebil and Kohgiluyeh and Boyer Ahmad. The sex ratio of male to female was 1.64. Based on the results, the incidence of leukemia in Iran is rising. Although a proportion of this increase may be due to improvements in cancer registration system but the probability of increase of incidence of leukemia exists because of the associated risk factors. Thus, the identification of the risk factors in different regions of Iran to prevent and to detect the disease at an early stage in recommended for disease control.

Traumatic brain injury is one of the important problems of world health with high mortality; probably, simultaneous hyperglycemia can intensify the harmful effects. Since there is no unique opinion in this regard, we aimed to study the effect of blood glucose at before, during and after operation on outcome of patients with traumatic brain injury.

A hundred patients with traumatic brain injury were studied during a prospective clinical trial study. We divided patients according to their preoperative blood glucose level to two groups of normo- and hyperglycemic. We measured and recorded blood glucose level during and after operation, in addition to the heart rate, blood pressure, saturation of oxygen (SpO2), duration of mechanical ventilation and outcome of patients in both groups.

Heart rate was significantly higher at 15th (P = 0.027), 60th (P = 0.018), 105th (P = 0.010) minutes and in recovery room (P = 0.006) in hyperglycemic patients; but as a general, the changes in heart rates were not significant in both groups (P = 0.610). There was no difference in SpO2 at different times. The mean arterial pressure (MAP) was higher at 45th (P = 0.025) and 60th (P = 0.016) minutes during the surgery; but as a general, there were no significant difference in MAP between the two groups (P = 0.850). Duration of mechanical ventilation was significantly longer in hyperglycemic patients (P = 0.009).

According to our findings, elevated blood glucose patients with traumatic brain injury may results in some intraoperative hemodynamic changes and affect their outcome. Therefore, monitoring of blood glucose in these patients is suggested.

Glioma is a type of brain tumor that occurs in the brain and spinal cord and is derived from glial cells. Frequency, survival and response to therapy in these tumors are dependent on age and sex. The survival rate varies from several months to years. In the current study, 3-year survival rate in patients with all kinds of glioma tumors who were hospitalized in Alzahra hospital, Isfahan, Iran, in the years 2001-2010 were evaluated. In the current study, the target population was the patients with all kinds of proven glioma who had resection surgery. The volume of the population was determined as all the patients with all kinds of glioma tumors in the years 2001-2010, who were operated in Alzahra hospital. The total number of patients was 490. Inclusion criteria were patient’s tendency for participation in the study, the accuracy of the patient’s basic information in the archive documents and lack of death at the hospital, in pre-, intra- and postoperation periods. According to these criteria, only 221 were eligible for inclusion. The information such as name, family, age, gender, tumor type, treatment type and telephone number were extracted from the list of the patients. The patients were contacted and questionnaires were completed. Microsoft Excel software was used for data analysis, so that its data were the number of people with any type of tumor, age, sex of the patients and the three-year survival rate of any tumor. The three-year survival was 8.7% in glioblastoma multiform, 100% in diffuse astrocytoma, epondymoma and pilocytic astrocytoma, 95.2% in oligodandroglioma, and zero in anaplastic astrocytoma. In this study, surgery plus radiotherapy in diffuse astrocytoma, oligodandroglioma and epondymoma increased three-year survival rate. In pilocytic astrocytoma surgery, as the first treatment, increased the three-year survival. In the case of glioblastoma multiform and anaplastic astrocytoma, surgery plus radiotherapy with or without chemotherapy briefly play role in increasing the survival rate.

Most of the patients undergoing cataract surgery are middle-aged and older ones, accompanying high prevalence of hypertension that needs control. We compared antihypertensive effects of magnesium sulfate, as an effective drug in blood pressure control with that’s of nitroglycerine and placebo. 105 patients were allocated with simple randomization in 3 groups of 35; group 1 received stat infusion of magnesium sulfate with a dose of 30 mg/kg during 5 minutes which continued with the dose of 1 mg/kg/minute until the end of surgery; group 2 received stat infusion of nitroglycerin with the dose of 1 µg/kg during 5 minutes which continued with the dose of 0.05 µg/kg/minute; and group 3 received the solution of dextrose 5% as placebo infused with the same volume and the same infusion rate. All the groups received intravenous (IV) sedation using midazolam 0.02-0.03 mg/kg and fentanyl 1-2 µg/kg with eye drop local anesthetic tetracaine 0.5% and undergone phacoemulsification cataract surgery. Hemodynamic parameters during operation, in recovery and at the ward entrance and exit time were recorded. There was no significant difference between the mean diastolic blood pressure among all the groups (P = 0.49). The mean systolic and mean arterial (MAP) blood pressures during the operation at the 30th minute, and then at 15th and 30th minutes in recovery and also at the ward entry and exit time, had lower amounts in magnesium sulfate and nitroglycerin groups compared to placebo group (P = 0.019). But, there was no significant difference between the magnesium sulfate and nitroglycerin groups (P = 0.060). The mean heart rate was not significantly different at any of the studied times among 3 groups (P = 0.170). The usage of magnesium sulfate in patients with hypertension is effective during and especially after phacoemulsification surgery cataract under local anesthesia just like nitroglycerine; but has no significant effect on the postoperative pain.

Poly(glycerol sebacate) (PGS) is a novel biological polymer for biomedical application with high biocompatibility, mechanical properties near to soft tissues of body and a adaptability of properties during synthesis. But, this polymer tends to undergo rather rapid biodegradation which is usually faster than peripheral nerve regeneration and needs optimization of degradability properties for using as a nerve conduit.

First, PGS pre-polymer was synthesized and then, equal to 5% of its weight, calcium titanate ceramic, which is highly biocompatible, was added to it and the acquired mixture was exposed to heat in vacuum oven to increase its strength. The obtained biocomposite came under scanning electron microscopy (SEM) image, Fourier transform infrared (FTIR) spectroscopy, in-vitro biodegradation and cytotoxicity evaluation.

A composite with high particle distribution was obtained which represented a chemical bond between its two precursors. The in-vitro degradation time showed 23% reduction in overall weight loss for the composite in comparison to pure PGS over a period of 60 days degradation. The cell culture showed more than 90% of viability after 5 days of culture for the composite.

Regarding to biodegradation rate, molecular mass and high cytocompatibility, this composite is encouraging enough to merit further investigation for nerve conduit application.

Recent evidence suggests that the interleukin-33/interleukin-1 receptor-like 1 (IL-33/IL1RL1) axis plays a critical role in autoimmune and inflammatory disorders; however, its mechanistic role in these diseases has not been clearly defined. The present study aimed to investigate the frequency of rs1342326 polymorphism of IL-33 gene and rs10204137 polymorphism of IL1RL1 gene with serum levels of IL-33 in multiple sclerosis (MS), asthma and healthy subjects In Isfahan Province, Iran. Samples were taken from the patients with asthma (140) or multiple sclerosis (140) and healthy controls (72). Different genotypes of T/G or G/A polymorphisms were studied using the high-resolution melting real-time polymerase chain reaction (HRM real-time PCR) technique. Serum levels of IL-33 were measured via enzyme-linked immunosorbent assay (ELISA). There was not any relationship between the frequency of polymorphism rs10204137 of IL1RL1 gene and susceptibility to multiple sclerosis or asthma. There was no significant correlation between the frequency of rs1342326 polymorphism of IL-33 gene in healthy subjects compared to those with asthma or multiple sclerosis. Serum levels of IL-33 were higher than in patients with multiple sclerosis or asthma compared to healthy subjects. Serum levels of IL-33 in the two groups of patient increased substantially compared to the controls.

One of the most lethal damages of the gastrointestinal tract is esophageal perforation. The prevalent causes of esophageal perforation are diagnosis interventions, trauma, and Boerhaave’s syndrome. Although esophageal perforation after vomiting is rare, but has a high mortality risk; therefore, early diagnosis and treatment is essential.Case Report: The patient was a 44-year-old man admitted to the emergency room due to severe chest pain with a history of vomiting after eating egg, 4 hours ago. Vomiting was not too severe and the pain was in the right chest. After the diagnosis of esophageal rupture, the patient underwent thoracotomy. As esophageal perforation is a real emergency, on-time diagnosis and treatment is vital.