مجله دانشگاه علوم پزشکی شهید صدوقی یزد
سال هجدهم شماره 2 (پیاپی 72، خرداد و تیر 1389)

Bone marrow transplantation is one of the treatment modalities in many hematologic disorders. In recent years, bone marrow transplantation is increasingly being delivered in the outpatient setting. Some studies suggest that outpatient transplantation has many advantages. The aim of this study was to compare the quality of life in outpatient and inpatient multiple myeloma patients after bone marrow transplantation. This research was a descriptive, comparative study. The quality of life of 35 multiple myeloma patients who had undergone bone marrow transplantation (20 outpatient and 15 inpatient) was assessed. An EORTC QLQ_C30 questionnaire was used for data collection. The questionnaire was completed on three occasions (before transplantation, 45 day after BMT and 90 day after BMT). Descriptive (mean, SD) and inferential statistics (Paired T Test, ANOVA Repeated Measures) were used for data analysis. Comparison of quality of life between inpatient and outpatient settings indicated that quality of life of outpatient group was significantly better than inpatient group in certain aspects including all functional scales, all symptom scales, physical functioning, nausea and vomiting, fatigue, role functioning and appetite loss, and after a period of 90 days after transplantation, there was a significant increase in quality of life of the members of the inpatient group with regards to social functioning (p=0.001), dyspnoea(p=0.05), insomnia(p<0.001) and diarrhea (p=0.07). Although both transplantation methods have their own advantages, but considering the point that outpatient setting results in betterment of quality of life in certain aspects, it is advisable that patients should undergo bone marrow transplantation in an outpatient setting.

The mitochondrial defects in Friedreich ataxia (FRDA) have been reported in many researches. Friedreich ataxia is an autosomal recessive neurodegenerative disorder caused by decreased expression of the Frataxin protein. Frataxin deficiency leads to excessive free radical production and dysfunction of respiratory chain complexes. Mitochondrial DNA (mtDNA) could be considered as a candidate modifier factor for FRDA disease. It prompted us to focus on the mtDNA and monitor the nucleotide changes of genome which are probably the cause of respiratory chain defects and reduced ATP generation. We searched the mitochondrial NADH dehydroganase I (ND1) gene by PCR-TTGE and DNA fragments showing abnormal banding patterns were sequenced for the identification of exact mutations. In 20 patients, we detected 3 mtDNA mutations which is novel in Friedreich ataxia. T4216C mutation results in conversion of Tyrosine to Histidine in 313 amino acid locations in ND1 and bioinformatics studies show that ND1 protein loses sixth intramembrane α chain. Our results showed that ND1 gene mutations in FRDA samples are higher than normal controls (P<0.001). It is possible that mutations in mtDNA could constitute a predisposing factor in combination with environmental risk factors that could affect the age of onset and rate of disease progression

Epileptic patients have special mental profile and experience emotional and psychopathological problems. Some studies have reported that epilepsy and psychopathology occur together. The aim of this study was to evaluate the mental profile of Complex partial seizure (CPS) and Grandmal seizure (GMS) patients and compare them with the control group. This descriptive-analytical study was carried out in 2008 at the neurological clinics of Isfahan and included 40 Patients with CPS and GMS epilepsy selected conveniently and control group included relatives of the patients. Psychological and personality profile was measured with MMPI inventory. The obtained data was analyzed with SPSS software, mainly through the analysis of Chi Square and ANOVA. The findings of this research showed that although the scores of clinical scales in MMPI are higher than control group, this psychopathology isn’t abnormal. Epileptic patients in hypochondria, depression and hysteria had more elevated levels in comparison with the control group, but this difference was significant only in CPS patients. The results showed that epileptic patients tend to have more psychological disorders than normal people. These findings emphasize the necessity for psychological treatment along with drug therapy.

Clinical findings affecting disability in stroke patients are important as presence of these factors determines the prognosis and future course of these patients. Consecutive stroke patients admitted at Ghaem hospital, Mashhad were enrolled in this prospective study in 2008. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia was evaluated in these patients. Disability score was based on the Modified Ranking Disability Score (MRDS), 72 hours post stroke. Mean of MRDS was analyzed by T test and Fisher tests and p<0.05 was considered as significant. A total of 329 stroke patients were investigated. Hemihyposthesia, hemianesthesia, hemineglect and homonymous hemianopsia was found in 37.4%, 13.8%, 7.9% and 7.3% of the patients, respectively. MRDS was significantly higher in patients with hemianesthesia as compared to other stroke patients, (p<0.001). MRDS of patients with hemihypoestheisa, hemineglect and homonyous hemianopsia was not significantly different than patients without these abnormalities (p=0.44, p=023 and p=0.83). Patients with triad of hemianesthesia, hemineglect and homonymous hemianopsia had significantly higher MRDS than others (p<0.001). Hemianesthesia is a clinical factor affecting sensory disability in cerebral stroke patients. Presence of the above triad could increase MRDS in these patients.

Smoking approval by friends and teachers seems to increase the probability of smoking by the students. This study aimed to determine whether adolescent smoking is associated with teachers or other students smoking, after controlling for confounders. A sample of the 3rd grade students of Tehran's high schools were asked to complete a 21 item questionnaire, including demographic and smoking habits. The comparisons of adolescent smoking pattern between two sexes and also smoking frequency of the family members, best friends and teachers between the smoking and non-smoking students, were performed. Furthermore, the association between smoking behavior and exposure to teachers smoking were assessed by a multivariate logistic regression analysis, adjusted for sex, parental, best friends, and sibling smoking. Odds Ratios were estimated. Among the 4591 students (aged 17-19, mean 17.53±0.59 years), including 2092 boys (45.6%) and girls, 250 boys (12.1%) and 131 girls (5.3%) were current smokers (p=0.001). The proportion of smoker and non-smoker students who have been exposed to teachers smoking inside the school building were 55.7% (209) and 29.3% (1191) respectively (p=0.001). The 220 (58.7%) exposed students to outdoors teachers smoking (on school premises) were smoker while 1205 (29.2%) were non-smoker (p=0.001). By adjustment of the parameters, adolescent exposure to best friend smoking and to teachers smoking on school premises was significantly associated with current smoking. Teachers smoking during school hours and best friend smoking are the two important determinants to be considered in any project aiming to establish tobacco-free schools.

Cancer is a disease that is determined by unnatural deformation and differentiation of cells.Cancer patients face psychosocial and physical problems that may have an impact on the patient's quality of life. The purpose of this study was to investigate the relationship between mental health and quality of life in cancer patients. This study was a correlational research. In this study, 90patients referred to Shefa hospital in Ahvaz were selected through convenient sampling in 2008. Data was collected by General Health Questionnaire and short form quality of life questionnaire (Sf-36) and analyzed using Spearman's correlation, t-test and ANOVAs test. The results showed that most domains in quality of life were correlated with mental health domains. General health perception and physical function domains were correlated significantly with 3 domains of mental health; anxiety, social function and depression. Somatoform symptoms were correlated significantly with mental health domain of quality of life (P<0.02). Finally, social function was correlated significantly with social dysfunction domain of life quality (P<0.05). Also, anxiety and somatoform domains of mental health had a more significant relationship in women than men (P=0.006 and P=0.025). From the quality of life domain, physical function had a more significant relationship in men than women (P=0.03), while bodily pain had a more significant relationship in women than men (P=0.001). According to the findings, many quality of life domains were correlated with mental health domains and cancer had an effect on various aspects of patient's life.

Annually, more than 14 million people are reported to be infected with Leishmaniasis all over the world. In Iran, this disease is seen in the form of cutaneous and visceral leishmaniasis, of which the cutaneous form is more wide spread. In recent years, cutaneous leishmaniaisis is diagnosed by PCR utilizing specific primers in order to amplify different parasite genes including ribosomal RNA genes, kinetoplast DNA or tandem repeating sequences. The aim of this research was to detect early stage cutaneous leishmaniasis using Multiplex-PCR technique.

In this study, 67 samples were prepared from patients with cutaneous leishmaniasis. DNA was extracted with phenolchloroform. Each specimen was analyzed using two different pairs of PCR primers. The sensitivity of each PCR was optimized on pure Leishmania DNA prior to use for diagnosis. Two standard parasites; L. major and L. tropica were used as positive control. DNA amplification fragments were two 115 bp and 683 bp for AB and UL primers, respectively. The sensitivity of two primers was not equal for detection of L. major and L. tropica. The sensivity of PCR with AB primer was 35 cells, while that for UL primer was 40 cells. The results of this study indicate that PCR is a sensitive diagnostic assay for cutaneous leishmaniasis and could be employed as the new standard for routine diagnosis when species identification is not required. However, the ability to identify species is especially important in prognosis of the disease and in deciding appropriate therapy, especially in regions where more than one type of species and disease are seen by clinicians.

β-Thalassemia (β-thal) is the most common hereditary disease in Iran which has been the home to one of the world's oldest and major civilizations. Different ethnic groups and tribes live in Iran, and there are more than two million carriers of β-thal in Iran. In the last two decades, β-thal mutations have been investigated in several Iranian provinces. This ethnic/genetic heterogeneity has resulted in a high number of different β-thal mutations. Comparison between different provinces shows that the mutation spectrum differs substantially in types and frequencies. A total of 60 mutations have been reported in Iranian patients and we present a review of these findings and describe the distribution, spectrum and experience of detection of β-thal mutations in Iran.