مجله دانشکده پزشکی اصفهان
پیاپی 503 (هفته سوم دی 1397)

So far, several scoring systems have been used to predict the prognosis of patients admitted to intensive care unit (ICU). Sequential organ failure assessment (SOFA) and acute physiology and chronic health evaluation III (APACHE III) are two of these scoring systems. In this study, these two scoring systems were compared in patients with trauma hospitalized in ICU. In this retrospective cross-sectional descriptive study, 100 patients were randomly selected from those who admitted to the ICU of Alzahra hospital in Isfahan, Iran in, during 2016-2017, and divided into two groups of living and dead. Demographic and clinical data and laboratory results were extracted and analyzed from patient medical files. Findings: The scores calculated by two scoring systems were significantly higher in the dead group than the living group. There was a significant difference between the two groups based on the qualitative scores of the SOFA system. Based on the receiver operating characteristic (ROC) curve, the sensitivity and the specificity was 90.32% and 94.20% for SOFA, and 90.32% and 86.96% for APACHE III, respectively. APACHEIII and SOFA scoring systems are with high sensitivity and the specificity to predict the prognosis of patients with trauma hospitalized in ICU, and cannot be considered superior to another. The simplicity of the SOFA in the calculation may make the assessment easier and less time-consuming.

Mendelian susceptibility to mycobacterial diseases (MSMD) is a rare immunodeficiency disease which is caused by interferon-gamma (IFN-γ) signaling impairment. Patients with MSMD are susceptible to infections with weakly virulent non-tuberculous mycobacteria (NTM) and the Bacillus Calmette-Guérin (BCG) vaccine strain. Regarding that a great number of identified mutations in MSMD are located on IFN-γ receptor 1 (IFNGR1) gene, this study aimed to evaluate IFNGR1 mutation in patients with MSMD in the central region of Iran.

We examined 31 patients suspected to MSMD based on defined criteria. IFNGR1 gene mutation analysis was performed on the DNA samples using polymerase chain reaction (PCR) and gene sequencing methods.

The sequencing of exons 1-6 of IFNGR1 gene in patients with MSMD was evaluated, and among 31 patients, six polymorphisms were found, that two of them were not reported before.

In this research, two polymorphisms were found in exon 1, rs17181457 and rs2234711, both of them increase the susceptibility to mycobacterial infection. The approach to treatment of infection in patients with MSMD is based on the kind of mutation. Therefore, assessment of gene mutation in these patients is helpful to choose the appropriate treatment.

Despite the very good medicinal properties of lavender essential oil and licorice extract, some factors, such as allergic reaction and being biodegradable, limit the application of them as candidates for pharmacotherapeutic treatments. Nano-emulsification is one of the ways to overcome these limitations. The aim of this study was to investigate the effects of nanoemulsion cream containing lavender essential oil and licorice extract on healing of deep skin wound in rat model. In this experimental study, nanoemulsion cream containing lavender essential oil and licorice extract was made using self-emulsifying method. To investigate its effect on wound healing process, a full-thickness skin wound was produced on 85 male Wistar rats. The wound area was digitally photographed at 2nd, 5th, 7th, 10th, and 14th days after surgery using a digital camera; then, the area was quantified using an image analysis system (Image J). Moreover, the expression of transforming growth factor-beta1 (TGF-β1), type I collagen (Col I), and Col III genes was evaluated using real-time polymerase chain reaction (real-time PCR) at days 2, 7, and 14. Findings: Nanoemulsion cream significantly decreased the surface area of the wounds faster than lavender essential oil and licorice extract cream (P < 0.010) and phenytoin (P < 0.050). Moreover, real-time PCR showed that topical treatment of wounds with nanomulsion cream increased the expression of TGF-β1, Col I, and Col III genes in rat’s skin (P < 0.01). Nanoemulsion cream containing lavender essential oil and licorice extract exhibits a promising wound healing potential towards excisional wound models in rats.

Regarding the possibility of perturbation due to the presence of dental root filling material (DFM) in treatment planning of patients with nasopharyngeal cancer, we aimed to evaluate the impact of this material on tumor control probability (TCP) and normal tissue complication probability (NTCP) using dose volume histograms (DVHs) of tumor and organ at risks, measured via treatment planning system. The optimization process of two intensity modulated radiotherapy (IMRT) techniques was performed by means of Prowess treatment planning system using 7- and 9-field 6-MV photons in two groups of 15 patients with nasopharyngeal cancer, with a difference in the presence or absence of DFM. After preparing DVHs, analysis and comparing of equivalent uniform dose (EUD), TCP, and NTCP were performed using Niemierko’s equivalent. Findings: In 9-field IMRT, there was statically significant decrease in mean EUD, TCP, and conformity index (CI) of tumor in patients with DFM; but there was no significant differences in homogeneity index (HI). Moreover, due to presence of DFM, there was statically significant increase in mean EUD and NTCP of mandible in both 7- and 9-field techniques, and in NTCP of left optic nerve in 9-field IMRT. Although for right eye, there was a statically significant decrease in NTCP by 7-field IMRT technique, due to presence of DFM. The effect of the presence of DFM on IMRT depends on field angles, and leads to significant decrease in TCP target volume, significant increase in NTCP of and EUD mandible and NTCP of left optic nerve, and significant decrease in NTCP of right eye.

Natural delivery process is accompanied by severe pain during labor, and various ways of reducing it have been presented so far, of them, spinal anesthesia is one of the most commonly used methods. The aim of this study was to compare the effect of spinal, epidural, and combined neuroaxial anesthesia on the maternal and fetal outcomes of normal vaginal delivery. In a clinical trial study, 105 pregnant women candidates for normal delivery were randomly assigned to three groups of 35. To reduce labor pain, the first group was under spinal anesthesia, the second under epidural anesthesia, and the third under combined anesthesia. The incidences of maternal and neonatal complications were determined and compared between the three groups. Findings: The mean Apgar scores of 1st and 5th seconds were not significantly different between the three groups, but the mean duration of stage two was significantly less in the group under epidural anesthesia (32.66 ± 7.57 minutes) compared to those in spinal (36.28 ± 6.38 minutes) and combined anesthesia (35.78 ± 7.39 minutes) (P = 0.027). Other complications, including bleeding and mortality, were not significantly different between the study groups. The incidence of maternal and fetal complications in the three groups under the spinal, epidural, and combined anesthesia did not show a significant difference, but the duration of the second stage of delivery was significantly lower in the group of epidural anesthesia. Therefore, it seems that the use of epidural anesthesia is preferable to the spinel and combined anesthesia to reduce delivery pain.