مجله دانشکده پزشکی اصفهان
پیاپی 105 (اردیبهشت 1389)

In 2005, multiple groups identified a high frequency of the V617F (G→T) mutation in the tyrosine kinase gene JAK2 in myeloproliferative neoplasms. In this study, we evaluated prevalence of JAK2 mutation and it’s clinical and laboratory correlates in patients with myeloproliferative neoplasms (MPNs). The JAK2 mutation was investigated with ARMS-PCR in 92 patients with myeloproliferative neop-lasms by simple randomized sampling. The JAK2 V617F mutation was detected in 86.6% (26/30) of patients with polycythemia vera, 46.6% (7/15) of patients with essential thrombocythemia, 61.5% (8/13) of patients with idiopathic myelofibrosis, and 14% (4/34) of patients with chronic myeloid leukemia. Polycythemia vera patients carrying the mutation dis-played a higher levels of WBC (P = 0.03); 61.5% (16/26) of these patients were female and 17 patients had sple-nomegaly. One patient had simultaneously JAK2 V617F mutation and Philadelphia chromosome. The differences in other groups were not significant. The mutation was confirmed by sequencing. These correlations imply that detection of this mutation will not only have a diagnostic value, but also a role in treatment given the development of STAT/JAK pathway inhibiting drugs.

Hormonal therapy is one of the most important regimens for treatment and prophylaxis of recurrences of breast cancer. Among drugs, aromateas inhibitors has established and important role in this field. Letrozole is the most common used drugs in this group in our country. Two brand names of letrozole are available in Iranian drug markets; femara and letrofem. The aim of this study was the comparison of acute side effects of these drugs. In This clinical trials study, 45 post menopausal women with breast cancer were divided in two groups after surgery and chemotherapy. First one contained 30 patient and the second ontained 15 patient treated with letrofem and femara respectively. Side effects were studied in three steps. Among 19 studied variables, there were significant differences in frequency and intensity of 7 variables between two groups. These variables were pain, arthralgia, nausea, myalgia, lower extremity edema, fatigue and vertigo. Letrofem had more sever side effects from view point of frequency and intensity in comparison with femara. Observed differences may be due to three reasons including different bioavailability, different levels of estrogen following drug administration and lower amount of samples due to high cost of treatments. Then, it is recommended that bioequivalency test and measurement of estrogen level will be done in future studies with more samples.

This study assessed to study Pediatric Index of Mortality-2 (PIM2) measure for outcome assess-ment of children admitted to pediatric intensive care unit (PICU) of Bahrami children’s hospital. A prospective cohort study was implemented in Bahrami Children’s Hospital affiliated to Tehran University of Medical Sciences. We studied consecutively all of the patients admitted in PICU from May 2007 through November 2008. Patients’ data were registered at the admission time in related to records. We calculated PIM2 measure and compared expected mortality risk with observed mortality by using logistic regression, ROC curve analysis and standardized mortality ratio. We analyzed goodness of fit of PIM2 index with Hosmer and Lemeshow test. Two hundred and forty patients were studied. Mean (standard deviation) of age was 31.427 (42.7978). one hundred and fifty (62.5%) were male and 90 (37.5%) were female. The model fitted the test data well (P = 0.741) and area under the receiver operating characteristic plot was 0.795 (0.715-0.875 for 95% C.I.) and standardized mortality ratio was 1.8 (1.28- 2.465 for 95% C.I.). Measurement of bilirubin with transcutaneous bilirubinometry from covered area of glabella in preterm infants undergoing phototherapy could be a useful predictor of serum bilirubin level. With this method, we could reduce blood sampling in preterm neonates. So, the need for blood transfusion, the pain from taking blood and its side effects will be reduced.

Dyssynergic defecation does not respond appropriately to routine treatments of constipation. Re-cently, researches have shown that biofeedback therapy is useful in anorectal dyssynergia. This study compared two treatment modalities for these patients.

Fifty nine subjects with dyssynergic defecation were recruited. They allocated randomly to two groups of balloon defecation training and biofeedback therapy. In the first group, a balloon was inserted into the rectum and inflated with water injection; so that the patient had the sensation of full rectum and thus the need to defecate; then the patient was asked to reject the balloon. In the biofeedback group, the pen electrode of EMG biofeedback was inserted into rectum and the patient tried to increase abdominal pressure and relax rectal muscles accordingly.

The findings of the study showed a reduction in constipation of both groups. The ability to reject bal-loon (volume and time) was significantly better in post-intervention measurements; better results were found in biofeedback arm of the study. Patient satisfaction after treatment reached to 52% by balloon training and 79% in biofeedback group. Report of incomplete evacuation and need for digital use during defecation stayed constant after treatment in balloon trained cases.

Biofeedback seems to be superior to balloon defecation training and did made measurable changes in subjective and objective variables of dyssynergia.

We tried to evaluate the diagnostic utility of HBME-1 in distinguishing between reactive meso-thelial cells and adenocarcinoma in body serous effusions. We examined 52 cytologic specimens of serous effusions processed by cell block technique retrieved from the pathology archive of Al-zahra hospital (Isfahan). They were categorized in two groups: Group I. 26 effusions containing reactive mesothelial cells from patients with no evidences of malignancy based on cyto-morphology, clinical data and imaging; and Group II. 26 effusions containing adenocarcinomatous cells from patients with diagnosis established by routine histology. Immunostaining with HBME-1 was performed using an Envision technique. Statistical analysis was performed with SPSS software. Statistical significance was found with HBME-1 when comparing both adenocarcinoma versus meso-thelial cells (P = 0.001). Also, we found HBME-1 outlined cell membranes in reactive mesothelial cells versus cytoplasmic pattern in adenocarcinoma cells (P = 0.001). The staining intensity for adenocarcimoma cells in-cluded: Negative in 7 cases (26.9%); score + in 4 cases (15.38%), score ++ in 11 cases (42.30%) and score +++ in 4 cases (15.38%). In mesothelial cells, Negative and score + was not seen, score ++ was in 3 cases (11.5%), and score +++ in 23 cases (88.5%) (P = 0.001). The staining pattern and intensity for HBME-1 is a usufull panel for differentiation of adenocarci-noma and mesothelial cells. The only limitation of this marker is ovarian carcinoma that shows the same pattern as reactive mesothelial cells.

Taking blood for bilirubin measurement is a common cause of blood sampling in premature in-fants. Transcutaneous bilirubinometry is a method of bilirubin measurement and its value in term newborns is well established. In some studies, transcutaneous bilirubinometry has been accepted for premature babies who did not receive phototherapy. However its value in assessment of bilirubin in preterm babies undergoing photo-therapy is not well known. The aim of present study was evaluation the accuracy of transcutaneous bilirubinometry in preterm neonates during phototherapy. We enrolled preterm newborns admitted to the neonatal unit of Shahid Beheshti hospital, Isfahan University of Medical Sciences with gestational age of 26-36 weeks and age of 2-22 days who needed blood sampling for determination of plasma bilirubin level. We measured bilirubin using BiliCheck from glabella and sternum within 30 minutes of blood sampling. We assessed 72 preterm infants with mean birth weight of 1381.7 gram and mean gestational age of 30.03 weeks. There were significant correlation between transcutaneous bilirubinometry of glabella and serum bilirubin levels (P < 0.05; r = 0.83). There were also correlation between transcutaneous bilirubinometry of sternal region and serum bilirubin levels but this was weaker than glabella (P < 0.05; r = 0.55). Measurement of bilirubin with transcutaneous bilirubinometry from covered area of glabella in preterm infants undergoing phototherapy could be a useful predictor of serum bilirubin level. With this method, we could reduce blood sampling in preterm neonates. So, the need for blood transfusion, the pain from taking blood and its side effects will be reduced.

Stressful life events have a detrimental effect on mental and physical health. Recognizing common stresses of students is fundamental for developing and designing different preventing programs. The study aimed to describe common stresses among students in Tehran for such programs. In this study, 761 students (girls, 51% and boys 49%) from middle schools (61%) and high schools (39%), from 5 educational areas of Tehran randomly were selected; they completed Students Stresses Questionnaire developed in deputy of Ministry of Health and Medical Education and pilot studied in 120 students. The instrument had enough validity and reliability. Results also, showed that academic and interpersonal stresses are the most common stresses of students. The most common academic stresses were test and grade anxiety and lack of interests to some courses. The most interpersonal stresses were introducing with new persons, neglect to abilities from teachers and staffs, psychological abuse from another students, inappropriate communications form other students, and lack of close friends. Stresses related to puberty and adolescence also were prevalent. High percent of students assessed physics of school as inappropriate. Family stresses were not prevalent. The results suggested the need for essential three psychoeducational interventions, stress-management or coping skills training, study skills and interpersonal skills training, in three levels, teachers/staffs, parents and students.

Patients with Langerhans cell histiocytosis are at particularly high risk for central diabetes insipi-dus (CDI) due to hypothalamic-pituitary disease. Langerhans cell histiocytosis (LCH) is a group of idiopathic disorders characterized by the proliferation of specialized bone marrow-derived Langerhans cells and mature eosinophils. Three disease variants were included in this description, eosinophilic granuloma, Letterer–Siwe disease and Hand–Schuller–Christian syndrome.Case Reprort: We report a patient of Langerhans cell histiocytosis-solitary eosinophilic granuloma of the mand-ible that presented with diabetes insipitus after biopsy of mass