مجله دانشکده پزشکی اصفهان
پیاپی 467 (هفته سوم فروردین 1397)

Medication-use evaluation (MUEs) is analyzing the drug usage pattern in a treatment center and comparing it to the standards. Therefore, medication-use evaluation studies are considered to be effective and useful. Caspofungin is the first of a new class of antifungals, the echinocandins. It is used for treatment of resistant fungal infections like invasive aspergillosis, candidiasis, and empiric antifungal therapy in neutropenic fever. This study aimed to assess the pattern of the consumption of caspofungin in patients hospitalized in an intensive care unit in Isfahan, Iran in 2015, and to compare the results with the standard amounts in literature.
This was a descriptive and cross-sectional (retrospective) study conducted in Alzahra hospital, Isfahan, Iran, based on the files of the patients hospitalized in the intensive care units in a six-month period in year 2015. 49 patients hospitalized in the intensive care units in this time period, had received caspofungin. The information was gathered by reviewing the patients’ medical records. Due to the specific objectives of the study, the extracted information was compared to the defined standards to be presented as percentages.
Findings: The most frequent uses of this drug was for treatment of pneumonia (38.8%), sepsis (32.7%), peritonitis (20.4%), and fever and neutropenia (1.8%). The duration of treatment differed from 1 to 56 days. The administered dose of the drug was similar to the model in 92% of the cases. Decreased hemoglobin and hematocrit were the most frequent recorded drug side effects (73.4%).
The cases of drug administration was similar to the standard model; but the dosage had a considerable difference, and the duration of use was significantly longer than the standard model.

Due to the high prevalence of diabetes and dyslipidemia, which are risk factors for diseases such as metabolic syndrome in today's modern society, especially in the working population, the aim of this study was to determine the effect of shift work on fasting blood glucose and lipid profiles in workers in Isfahan City, Iran, during the years 2014-2015.
In this cross-sectional study, 6983 employees referred to labor centers for periodic examinations were entered according to the inclusion and exclusion criteria. The patients were divided into three groups based on the type of work shift as day, fixed night, and rotate shift workers, and two groups based of type of work as official and non-official workers. The level of blood glucose and lipid profiles [cholesterol, triglyceride, low-density lipoprotein (LDL) and high-density lipoprotein (HDL)] were evaluated and compared between the groups.
Findings: There were no significant differences between three groups according to the levels of fasting blood glucose (FBS), triglyceride, and high-density lipoprotein (P > 0.050); but there was a significant difference between the three groups based on the cholesterol and low-density lipoprotein (P Based on the results of this study, cholesterol and low-density lipoprotein levels was higher in day shift worker than fixed night and rotate shift workers in high sample sizes of workers in Isfahan City.

Some of studies showed intraepithelial lymphocyte and CD3 marker can be used in diagnosis of celiac disease with a high sensitivity and specificity, but there is controversy in these studies. This study aimed to evaluate and specify the cut-off point of intraepithelial lymphocyte with Hematoxiline-eosine (H&E) and immunohistochemistry (CD3 marker) in duodenal biopsy of children with celiac disease.
In this cross-sectional study, 113 under 12-years-old children candidated for duodenal biopsy were enrolled. The number of intraepithelial lymphocytes in Hematoxiline-eosine and CD3 methods were determined, and based on pathology results, the cut-off points and diagnostic values of the two methods were calculated.
Findings: The best cut-off points for Hematoxiline-eosine and CD3 methods was 16 and 18, respectively. The sensitivity, specificity, false positive, false negative, positive predictive value, negative predictive value, and accuracy were 93.8, 86.6, 13.4, 6.3, 53.6, 98.8, and 87.6 percent for Hematoxiline-eosine, and 87.5, 93.8, 6.2, 12.5, 70.0, 97.8, and 92.9 percent for CD3, respectively.
Count of intraepithelial lymphocytes along with CD3 marker can help to detect celiac disease, especially when there is a controversy in between Hematoxiline-eosine and serology results. More studies is recommended to detect diagnostic values of these markers better.

To prevent complications during surgical procedures, having knowledge about the anatomical variation of renal arteries in different races is important. This study aimed to determine the frequency of anatomical polymorphism of renal artery in Isfahan City, Iran.
Throughout a cross-sectional study on 129 patients referring to Alzahra hospital for kidney or abdominal multislice computed tomography angiography with multiple detector computed tomography (MDCT) in years 2015-2016, the arterial properties of kidneys on both sides were examined. The number of arteries was evaluated in terms of their laterality, location of the vasculation in kidney tissue, the number of accessory kidney arteries, and the patient's gender.
Findings: At least one additional artery was found in 15.5% of the right kidneys, and 17.1% of the left kidneys. Besides, the diameter of the accessory renal artery to the left in 14.3% of cases was the same as the major artery size, and in 85.7% smaller than the main artery; while all the right arteries (100%) were smaller than the main artery. There was no significant difference between the number of main and accessory renal arteries on the right or left sides between men and women. There was no significant difference between the number of main and secondary arteries between the two left and right sides.
Renal artery has anatomical variations and should be further investigated to prevent surgical complications. We recommend that a study with larger sample size be designed to compare anatomical variations between left and right accessory renal arteries in the Iranian population.

Non-Hodgkin lymphoma is the most common cancer in the world. This study aimed to determine the correlation between the serum level of free light chain ratio and age, and subtype and stage of the disease.
In a cross-sectional study, 59 patients with lymphoma who presented to Seyyed-al-Shohada hospital, Isfahan, Iran, were investigated. Subtype and stage of disease were specified via clinical exam and histologic and radiologic studies. Prognostic laboratory factors such as B2-microglobulin (B2MG), albumin, lactate dehydrogenase (LDH) and (ESR), in addition to serum free light chain (kappa and lambda) using nephelometry method were measured. The data were analyzed using SPSS software
Findings: There was no relationship between the mean serum level of free light chains and B2-microglobulin (P = 0.193, r = 0.173, and P = 0.170, r = 0.181 for lambda and kappa chains, respectively). Mean serum level of lambda chain was higher among the patients with bone marrow involvement and B-symptoms (fever, night sweats, and weight loss) (P = 0.021), but the mean serum level of albumin was lower among these patients (P = 0.025).
In patients with bone marrow involvement and presence of B-symptoms, only serum lambda levels were higher than those without it. There were no correlation between the level of serum free light chain ratio and age, and subtype and stage of disease.