Iranian Red Crescent Medical Journal
Volume:11 Issue: 4, 2009

Transplantation of hematopoietic stem cells (HSCT) has become the standard treatment for many patients with congenital or acquired disorders of the hematopoietic system or with chemo-radio or immuno-sensitive malignancies. HSCT has undergone rapid expansion over the past two decades. Despite the high cost and the complexity of the procedure, HSCT has developed in developing countries. The transplant program was established in Shiraz University of Medical Sciences in 1993 in Shiraz, southern Iran and is a referral center for about 10 million patients with hematology-oncology diseases. From 1993 to 2009, more than 450 allogeneic and autologous transplantations were undertaken. Since 2003, stem cell sources from the bone marrow have changed to peripheral blood for almost all disease indications. The main indication for HSCT is now the hematologic malignancies instead of hemoglobinopathy (thalassemia major). From 1993 to 2007, HSCT was performed on 155 blood transfusion dependent patients with thalassemia major with disease-free survival and overall survival of 71% and 77%, respectively. During this time, 127 leukemia patients underwent allogeneic HSCT including AML (n=68), ALL (n=30) and CML (n=29). In this group, long term disease-free survival rate (cure rate) was 67%, 60% and 62%, respectively. Even HSCT is rising rapidly in during the five past years; however, when the total transplantation to the total number of population is compared in our region, the rate is still low. It seems that the government should support the therapeutic approaches more in our country and help to overcome the difficulties.

The concept of Continuing Medical Education in medical sciences has been rapidly gaining popularity during the last decades. The objective of this study was to assess the satisfaction of medical profession graduates participating in the programs of Continuing Medical Education (CME) in terms of their professional requirements. In a cross-sectional, descriptive analytical study, a reliable and valid retest questionnaire was used to determine the satisfaction from continuing medical education CME program. One hundred and three medical profession graduates who had participated in CME program in 2006 were enrolled. The satisfaction for anesthesiologists with the compatibility of CME programs with their professional requirements was 28.3%; for general practitioners and pediatricians with the capability of professors in presenting the program, 40%; and for gynecologists and obstetricians with the capability of 31.6%. We conclude from the results of this study that a high satisfaction was noticed among medical professionals that may be due to previous works of researchers who have assessed the needs precisely and standardized the modern teaching methods.

For many years, prostate-specific antigen (PSA) was used to screen prostate cancer (PC) patients. However, recent controversial findings have cast doubt on the accuracy of this biomarker for diagnostic and prognostic purposes, and have stimulated the search for new candidates. This study was conducted to determine the capability of a soluble adhesion molecule known as soluble vascular endothelial cadherin (sVEcadherin) or CD144 to distinguish prostate cancer or benign prostate hyperplasia (BPH) patients from healthy individuals. Patients recently diagnosed as having PC (N=35) or BPH (N=35) and age-matched controls (N=30) were study enrolled. The concentration of sVE-cadherin and PSA was measured by ELISA. Gleason score in patients with PC was determined by pathological examination of tumor biopsies. The concentration of sVE-cadherin in the serum of patients with PC and BPH was significantly higher than that in the healthy men. No association was found between the concentration of this soluble adhesion molecule and PSA values. Moreover, concentrations of sVE-cadherin did not correlate with Gleason scores in patients with PC. The high concentration of sVE-cadherin in our patients suggests that this bio-marker is a potentially useful tool to identify high-risk patients. However, further research in patients with PC and other pathological conditions is needed to support the efficacy of this molecule in PC screening.

Several complications may occur when blindly passing through the retropubic space using trochars or needles in treatment of female stress urinary incontinence (SUI). This study evaluates using sling material without any manipulation of the retropubic passages rout for avoiding many common complications of female stress urinary incontinence. Thirty two patients with SUI and mix urinary incontinency who were operated between May 2004 and September 2007 using this new technique were enrolled. A patch of 3 1.5 cm of rectus fascia was dissected and the two corners of rectus fascia were sutured to the arcus tendineus fascia pelvis bilaterally. The fascia was placed under the suburethral layer like a hammock and the bladder neck was suspended in the position. Cure rates and adverse events were assessed approximately within 24 months after surgery. Twenty eight patients (87.5%) were successfully cured while none of the patients had any adverse events of urinary retention, post void residual urine, bleeding, hematuria, infection, fever, hernia, urethral erosion, ureter injury and bladder or bowel perforation. Our results showed that our surgical method was very safe with high success rate for treatment of SUI without any manipulation of the retropubic passages rout that based on De Lancy Hammock hypothesis.

Hydrogels are one of the commonly used dressings for chronic ulcers. Nowadays, much therapeutics can be delivered to the wound or circulation by the gels. This study was conducted to evaluate the efficacy of Iranian hydrogel in wound healing in rat as an animal model. Thirty four Wistar male rats were anaesthetized and a full thickness circular skin wound was created by excising the dorsum of the rats. The animals were divided into two groups. In the experimental Ir gel group, the wounds were dressed by hydrogel and in the control NS group by conventional moist normal saline gauze. The wound areas were measured on days 1, 3, 7 and 12 for comparing the wound healing rate in the two groups. Laboratory investigation, skin tensile strength and histopathology of the healed tissues were also considered for evaluation. Mean percentages of wound contraction on the 3rd, 7th and 12th days were not significantly different between the two groups. The differences in skin tensile strength, in the two groups, on days 15 and 30 were not significant. Histopathologically, wound repair was excellent in 6 (60%), good in 3 (30%) and poor in 1 (10%) of specimens in control NS group while these figures were 6 (60%), 4 (40%) and 0 (0%) in the Ir gel group respectively and the difference was not statistically significant. The effect of Iranian hydrogel effect on wound healing in rats was identical to moist gauzes. As Iranian hydrogel did not have any adverse effects and was easily removed from the wound, it can be safely used for dressing of wounds.

Yeasts are increasingly implicated in serious systemic infections. The aim of this study was to identify Candida albicans and C. dubliniensis from isolates of immunocompromised patients and evaluate the in vitro antifungal activities of them against antifungal agents. One hundred and seventy eight C. albicans were isolated by routine methods from 403 immunocompromised patients. All isolated C. albicans were inoculated on CHROMagar Candida medium. The carbohydrate assimilation patterns of all the isolates were studied, using the API 32C system. To identify C. albicans and C. dubliniensis, PCR was done by specific primers. The susceptibility test for the isolates was performed by a broth microdilution assay, according to the Clinical and Laboratory Standard Institute. Of 178 isolates C. albicans, six were C. dubliniensis with PCR assay, and 7% were resistant to amphotericin B, 4.6% to fluconazole, 7% to itraconazole, 1% to nystatin, 2.3% to voriconazole, and 7% to ketoconazole. None of the C. dubliniensis isolates were resistant to the six anti-fungal agents. It would be convenient to carry out antifungal susceptibility studies in order to establish the in-vitro activities of antifungal agents against local isolates and also to detect shifts toward resistance as early as possible.

Pulmonary complication of IBD includes airway inflammation involving small and large airways, pulmonary paranchymal disease and serositis. The aim of this study was to determine the prevalence of Pulmonary Function Test (PFT) abnormality in ulcerative colitis (UC) patients. During spring and summer of 2006, PFT (spirometry and body box plethysmography) of 50 UC patients were compared with 50 healthy persons matched for age and sex (control). Data collection form including demographic specification and UC condition were filled. Mean age of patients was 37.2 years (SD=14.5). Active UC was seen in 24% of patients while 18% of patients suffered from severe UC. PFT results included 42% air trapping (only increase in residual volume/total lung capacity), 20% small airway obstructive pattern (only decrease in maximal expiratory flow at 25-75% of vital capacity), 12% restrictive ventilation defect, 2% obstructive airway, 2% hyperinflation and 6% upper airway obstructive pattern. There was a significant relationship between small airway obstructive pattern and duration of UC and no relationship was noticed between other pulmonary disorders and severity, activity, duration of UC. According to high prevalence of air trapping, small airway disease may be the prominent feature of lung involvement in UC patients. Therefore a meticulous work up for respiratory diseases is necessary in UC patients.

Irritable Bowel Syndrome (IBS) is an important public health problem, owing both to its high prevalence and its impact on the quality of life. The purpose of this study was to investigate the prevalence and risk factors of IBS and its relationship to life style in Qashqai migrating nomads with a different lifestyle in Fars province, southern Iran. In summer 2006, 748 Qashqai migrating nomads aged 25 years or more were enrolled, using a multiple- stage stratified cluster random sampling method. A questionnaire consisting of demographic data and IBS symptoms was completed for each subject. For about 50% of them, SF 36 questionnaire was also completed. The prevalence rate of IBS was 11.8% and there was a close relationship between IBS and the life quality. The prevalence of IBS in Qashqai migrating nomads was higher than the urban population in the area with a close relationship to the life quality.

In order to improve culture conditions for optimal spermatogenesis, quantitative assessment of the male germ cell gene expression profile upon spontaneous ES cell differentiation is necessary. In this study, the quantitative expression profile of Piwil2, germ-line specific marker, during the early stage of embryoid body (EB) formation and differentiation (0-3-day-old EB) was studied. CCE mouse embryonic stem cells (ESCs) were cultured in DMED containing 20% fetal bovine serum (FBS) for 1, 2 and 3 days. The total RNA was isolated from ESCs, 1-3-day-old EBs, and adult testis as positive control. cDNA was prepared and quantitative real-time PCR was done for Oct-4 to study the pluripotency of this cell line. Also, the molecular pattern of Piwil2 expression in developing EB was investigated. Our quantitative results confirmed the pluripotency of CCE mouse ESC line and showed that Piwil2 was expressed in undifferentiated CCE mouse ESC line. Our results also showed that expression of Piwil2 increased significantly during the process of EB formation and differentiation up to 2-day-old EB and decreased non- significantly in 3-day-old EB. Our results suggest that EB provide a cellular environment similar to the early embryonic microenvironment and cause the efficient and progressive germ cell lineage differentiation in this system.

In recent years, immunohistochemical markers have provided considerable contribution to salivary gland tumor diagnosis and classification. The aim of this study was to evaluate diagnostic value of various cytokeratin markers and smooth muscle actin (SMA) in differential diagnosis of pleomorphic adenoma (PA) and adenoid cystic carcinoma (ACC). In this retrospective study, 35 cases of salivary gland tumors composed of 19 PA and 16 ACC were selected and immunohistochemical staining with six cytokeratin markers (CK7, CK8, CK13, CK14, CK17 and CK18) and SMA were performed. The positivity of these markers in both typical and atypical areas of each tumor was compared. Positivity was defined if 10% or more of the cells were immunostained. In the PA group, there was no difference between luminal and stromal expression of CK7, CK 8, CK 13, CK 14, CK 17, and CK 18 in both typical and atypical areas except SMA that was not expressed in the atypical area. No statistically significant differences were found between the expression of CK7, CK 8, CK 14 and CK 18 in both typical and atypical areas of ACC group, with no expression of SMA in atypical area. It seems that the immunoprofile of the atypical area of both PA and ACC are similar to each other and IHC does not help to differentiate them.

Locally advanced breast cancer is a presentation form of cancer with poor prognosis. The optimal method of treatment for these cases remains unclear. In this trial, the role of low dose celecoxib combined with neoadjuvant chemotherapy in locally advanced breast cancer was evaluated. Fifty women with pathologically proven locally advanced breast cancer were enrolled. All patients received preoperative chemotherapy with CAF (Cyclophosphamide 600 mg/m2, doxorubicin 60 mg/m2, 5-FU 600 mg/m2) regimen. They were randomly assigned into two groups. The first group received oral celecoxib (100 mg twice daily) concurrently with chemotherapy and the second group was offered placebo. Chemotherapy was administered every three weeks and celecoxib continued until one week before the surgery. The patients received an average of 3 months treatment. The size of breast mass was measured before each cycle of chemotherapy by a caliper. The pathologic response rate was the primary endpoint of the study. In this trial, 50 patients were eligible, of whom 44 were evaluable. There were 25 patients in the celecoxib group and 25 patients in the placebo arm. Two patients in each group developed metastasis during the treatment course and two patients in group one could not tolerate celecoxib and quit it, so they were excluded from the trial. There was no statistically significant difference in terms of partial or complete response (90.5% vs. 87.0%) between celecoxib and placebo groups. Histological type, grade and hormonal receptor were similar in the two groups. No significant association was observed between menstrual status, size of mass at presentation and response to celecoxib. This study suggests that the use of celecoxib with a dose of 100 mg twice daily combined with neoadjuvant chemotherapy does not improve response rate in locally advanced breast cancer.

It is very important to detect biliary atresia in a timely manner to prevent progressive damage to the liver. Our attempt was to formulate our diagnostic approach to infantile cholestasis in Mofid Children''s Hospital in Iran. Forty two records of infants with prolonged conjugated cholestatic jaundice from 2003 to 2008 were reviewed with regard to the infants’ gestational age, birth-weight, stool color, liver function test results (total bilirubin, direct bilirubin, ALT, AST, alkaline phosphatase, albumin, globulin, and cholesterol), ultrasonography, hepatobiliary scintigraphy findings, liver biopsy results and ultimately intra-operative cholangiographies (IOC). Total bilirubin, direct bilirubin, AST, AST to ALT ratio, cholesterol, and globulin were significantly higher in infants with biliary atresia (BA) as compared to those in the other group. We found that gestational age and birth weight were significantly lower in infants without BA. Stool color sensitivity, specificity, positive predictive value, and negative predictive value in diagnosis of BA were 100%, 83%, 81%, and 100%, respectively. These figures for triangular cord (TC) sign were 72%, 91%, 86%, 81%, respectively and for hepatobiliary scintigraphy were 100%, 85%, 100%, and 85%, respectively. In biliary atresia, history, physical exam, and liver function tests can be the first steps in diagnostic algorithms followed by colored stool. However, if TC is not visualized, hepatobiliary scintigraphy is suggested. If excretion of tracer does not occur, liver biopsy is indicated. The definite diagnosis would be possible by an intraoperative cholangiography

Backgound: The ultimate goal of oral health care providers is not only to restore function, but also to relieve pain. This study was undertaken to compare the analgesic efficacy of ibuprofen, celecoxib and tramadol in patients after extraction of mandibular third molar teeth. Forty one patients entered our study and were randomly divided into three groups. Group 1 received ibuprofen (600 mg) and groups 2 and 3 received celecoxib (200 mg) and tramadol (100 mg) respectively, 8 hours and one hour before extraction of mandibular third molar teeth. The patients reported their pain severity in a questionnaire four and eight hours after the tooth extraction. To evaluate the side effects of the drug, the patients were asked to report if they had any problem using the drug. Fourteen patients received ibuprofen, 15 celecoxib and 12 tramadol for relief of pain. The pain severity in ibuprofen group, 4 and 8 hours after tooth extraction was less than celecoxib, and was less in these two groups when compared to tramadol group but no significant difference was found between the three groups. No undesirable side effects were reported in ibuprofen and celecoxib groups, but side effects such as headache, nausea, vomiting, oral dryness, drowsiness, tremor and vertigo were observed in the tramadol group. All patients who used tramadol were not satisfied from the drug while it had disturbed their daily activities. Regarding the very little side effects of celecoxib and its desirable analgesic effects, it can be administered as one of the analgesic drugs of choice in dentistry.

Many factors are important determinants in the outcome of cardiopulmonary resuscitation (CPR) such as quality of CPR, age of patients, co morbidities, time and location of arrest, and skill of rescuers. This study was conducted to evaluate the efficacy of CPR in Shiraz, southern Iran. From October 2007 to March 2008, all patients who received in-hospital CPR in Nemazee Hospital affiliated to Shiraz University of Medical Sciences were enrolled. Two standard scales of ROSC (Return of Spontaneous Circulation) and DR (Discharge Rate) were used to evaluate the efficacy of CPR. Two hundred and seventy one patients (45.1%) had ROSC while 329 (54.9%) died immediately after resuscitation. Among ROSC patients, 18 (6.6%) cases were discharged from the hospital (3% of study population). Although ROSC was comparable with developed countries, but the DR was lower. It shows that in our area, post-resuscitation care needs more attention in relation to organized trainings and the skills in postresuscitation care together with expansion of the facilities.

Autism is a heterogeneous condition and the possible pathogenic role of several different factors was postulated. Previous studies reported the existence of a linkage between autism and celiac disease (CD). The aim of this study was to determine the association between autism and CD by anti-gliadin (AGA), antiendomysial (AEA) and tissue transglutaminase (tTG) antibodies. Thirty four consecutive autistic children (18 boys and 16 girls) aging 9.2±4.1 years (range 4-16 years) and thirty four age- and sex- matched healthy anonymous blood donors (18 boys and 16 girls) aging 10.8±4.0 years (range 4-16 years) were included. None of the patients and controls had symptoms (or positive family history) suggestive of specific gastrointestinal diseases. AGA and AEA antibodies (IgG and IgA), and IgA-tTG were detected by ELISA. The individuals with positive serology were offered duodenal biopsies. IgG-AGA was found in 4 patients (11.8%) and 2 controls (5.9%), while IgA-AGA was found in none of the patients and controls. All patients presented normal values of IgG and IgA-AEA similar to the control group. There was no significant relationship between the levels of AGA and AEA antibodies and the severity of autism in the patient group. The levels of IgA-tTG in four patients (but no controls) were in the borderline range and two of them were found to have mild villous changes with chronic inflammatory cells. However, characteristic histological features of CD were absent. No evidence was found that children with autism were more likely to have celiac disease than children without autism.

Pseudoexfoliation (PEX) syndrome leads to elevated intraocular pressure and consequent glaucomatous damage of the optic nerve. This study was performed to investigate the frequency of MTHFR, 677 C-T polymorphism and homocysteine (Hcy) levels in Iranian patients with PEX and PEX glaucoma were compared to that in normal population. Thirty four patients with PEX, 27 with PEX and glaucoma, and 32 control subjects were enrolled. Pregnant patients with any systemic disorder such as hypertension and diabetes mellitus, usage of vitamin supplements or any condition affecting homocysteine level were excluded. Fasting total homocysteine (tHCT) levels of all the participants were determined, using an ELISA method and values exceeding 14 micromole /L were considered as an elevation. MTHFR genotyping was performed by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). Genotyping of polymorphism was done with polymerase chain reaction. The patients'' mean age was 67 years (range 50-90 years) in all three groups and the male to female ratio was 2:1. The mean plasma homocysteine level was 13.95±8.7 in the PEX, 16.37±8.2 and 14.22±11.32 in the PEX glaucoma and the control group, respectively. The rate of C677T polymorphism was 44% in the PEX, 52% in the PEX glaucoma, and 40% in the control group. The result of this study implies that neither C677T polymorphism nor hyperhomocysteinemia can be considered as major risk factors for PEX or PEX glaucoma in Iranian population.

In patients with coronary artery disease (CAD), assessment of viable myocardium has important prognostic implications. The aim of this study was to compare contrast-enhanced magnetic resonance imaging (ce–MRI) with single–photon emission computed tomography (SPECT), using 99mTC–sestamibi for detection of myocardial viability. Twenty-seven patients with coronary artery disease and an ejection fraction (EF) <40% were enrolled. For the ce–MRI, the segmental extent of hyperenhancement (SEH) was quantified after the administration of a gadolinium–based contrast agent, and for the SPECT a 4-hour redistribution protocol was used. For the assessment of EF, we used echocardiography. Comparison of viability assessment was performed in 1458 segments. Agreement between two modalities was obtained in 1332 (91.4%) segments, resulting in a kappa value of 0.8. In 126 segments, we had discordant results. 102 SPECT viable segments were non-viable according to ce–MRI and 24 ce–MRI viable segments were described as non-viable by SPECT. SPECT was comparable to ce–MRI for myocardial viability assessment, but we were not able to define which of them was superior.

We describe an18-year old male patient with a 5 months previous history of swelling at the posterior mobile part of the tongue. The patient had difficulty in swallowing and speaking at the referral time. Examination of the oral cavity showed a swelling of 2x2 cm on the posterior part of the tongue, more towards the right side. Macroscopically, the entire lesion was removed with its capsule. Histopathological examination of the surgical specimen showed a schwannoma.

We describe a case of a 12-year old girl who presented with abdominal pain. A large abdominal mass was discovered on physical examination. Preoperative studies including abdominal ultrasonography and CT scan were performed, but they could not accurately determine the nature of the tumor. At laparotomy, a large cystic tumor of the small bowel was found. Histopathologic examination revealed a tumor of cystic lymphangioma. Although lymphangiomas are rare, especially in the abdomen, they may sometimes present as abdominal pain and acute abdomen, causing complications that require emergent surgery.

While serotonin reuptake inhibitors (SSRIs) and behavioral therapy are the first-line agents in treatment of obsessive-compulsive disorder (OCD), 40-60% of patients with the disorder do not respond to therapy. So other neurotransmitters may play a role in OCD. In this regard, there has been particular interest in the dopaminergic system, with various antipsychotic drugs having been used as adjunctive therapy for refractory OCD. This study describes the efficacy of ziprasidone as adjuncts for treatment-resistant OCD in a young female adolescent.