مجله دانشگاه علوم پزشکی اراک
سال پانزدهم شماره 2 (پیاپی 61، خرداد و تیر 1391)

Leukemia is the most common type of cancer in children which its relapse decreases the patients’ survival rate. The aim of this study was to determine the risk factors involved in leukemia relapse in patients in Shahid Faghihi Hospital, Shiraz, during 2004-2009 years.

In this retrospective cohort study, 280 patients with acute lymphoblastic leukemia and acute myeloid leukemia were included. Patient characteristics were analyzed with respect to their association with recurrence through Chi-square test, Fisher’s exact test, and logistic regression model using SPSS software version 16 (P-value<0.05).

Logistic regression model revealed a statistically significance relationship between age and recurrence of the disease (odds ratio (OR) = 0.35, 95% confidence interval (CI) = 0.15-0.82), odds ratio of relapse in the 5-10 years old age group was 0.35 times more than the 0-5 years old age group (p=0.01).

Noticing the greater likelihood of relapse in 0-5 years old age group compared with the 5-10 years old age group, more attention and better follow-up for decreasing the side effects of the disease and enhancing the survival rate of the 0-5 y/o age group are recommended.

Acute pancreatitis is a common cause of abdominal pain, without any characteristic signs, symptoms, or a gold standard diagnostic modality. The purpose of this study was to evaluate the diagnostic value of urine trypsinogen-2 strip test in acute pancreatitis. In this cross-sectional study, 76 patients with abdominal pain suspected to acute pancreatitis who were admitted to the Emergency ward of Valiasr Hospital, Arak, were evaluated. In 46 patients, acute pancreatitis was confirmed (pancreatitis group), whereas in 28 patients, acute pancreatitis was ruled out (control group). In both groups serum levels of amylase, lipase, CRP, and urine trypsinogen-2 were measured by quantitative and qualitative methods. Sensitivity and specificity of the tests were determined and data were analyzed using SPSS software. Urine trypsinogen-2 dipstick was positive in 36 of the 45 patients in the pancreatitis group (sensitivity: 80%) and in 2 of the 28 patients in the control group (specificity: 92.8%). Urine trypsinogen-2 ELISA test was positive in 41 of the 45 patients in the pancreatitis group (sensitivity: 91.1%) and in 4 of the 28 patients in the control group (specificity: 89%). Amylase sensitivity and specificity were equal to 82.6% and 75%, respectively. Lipase sensitivity and specificity were 76% and 85.7%, respectively. Urine trypsinogen-2 dipstick can be used to differentiate acute pancreatitis from other causes of abdominal pain. This rapid, easy-to-use, and accurate test can be used in emergency wards and primary health care units with limited diagnostic facilities.

The aim of this study is to assess antioxidative and pro-oxidative efficacy of ascorbate on serum albumin during iron-induced oxidative stress. In this experimental study, albumin was placed in the oxidative system containing iron ions and different concentrations of ascorbate. To monitor albumin degradation, sodium dodecyl sulfate polyacrylamide gel electrophoresis was performed according to Laemmli procedure. Oxidative modification of albumin was demonstrated using a method for determination of carbonyl groups by 2,4-dinitrophenylhydrazine. By applying the carbonyl assay, ascorbate showed a dual effect: initial pro-oxidative effect on albumin changed to an antioxidant one in a dose-dependent manner. Our findings showed prooxidant effects for ascorbate in low concentrations (0-100 µM) and antioxidant effects in higher concentrations (100-300 µM). Also, electrophoretic pattern of plasma proteins showed significant protein aggregations in the range of 35 to 45 kDa of MW and protein degradations in the range of 115 to 180 kDa. Ascorbate can produce reactive oxygen species and can also inhibit the production of these oxidants in the presence of iron ions as well. These findings may be directly applicable to oxidative states during the administration of ascorbate and may be important in preventing oxidative modifications of proteins in blood circulation and other biological fluids.

Previous studies in Iran and around the world have indicated the high rate of medicines use. In recent years, medicine use has continued to rise in spite of attempts made by the Ministry of Health and Medical Education in Iran. Therefore, it seems that in addition to the reasons considered in previous studies, there are other reasons for this problem in Iran. One of the parameters involved in this problem is the high medicine use among the clinical staff. Thus the aim of this study is to compare medicine use among clinical and non-clinical staff members. In this cross-sectional study, information about the monthly use of medicines was obtained by means of a questionnaire administered to eight groups of clinical and non-clinical members: first-year medical students, first-year non-medical students, interns of medicine, forth-year non-medical students, general physicians, specialists, academic members with M.Sc, and academic members with PhD degrees. The results showed that medicine use decreased with increase in education level in both groups. In addition, the comparison of medicine use between clinical and non-clinical groups showed that there is not a significant difference for most medicines among the first- and second-year students but medicine use significantly increased among general physicians and specialists compared to the control groups. The results of this study showed that medicine use among clinical staff should be considered in controlling medicine use in Iran.

Live attenuated Shigella vaccines have shown promise in inducing protective immune responses in human clinical trials. The aim of this study was to design and construct pDS132::∆icsA as a suicide plasmid for targeted deletion of a region of icsA gene in Shigella.

In this experimental study, species and serotypes of Shigella isolated from diarrhea samples of children at Firozabadi and Milad Hospitals of Tehran were confirmed by using serological and PCR tests. Identification primers of icsA gene were designed and then cloned to the pGEM-5zf vector and sequenced. According to icsA restriction enzyme map, 1751 bp of icsA gene was deleted by HincП restriction enzyme and the ∆icsA was constructed successfully. The pGEM∆icsA vector was digested by use of SphI and SalI enzymes and was then cloned to a suicide vector (pSD132). Precision of the process was confirmed by phenotype and genotype tests.

The Shigella dysenteriae type 1 strain was verified by serological tests and PCR. Sequence of the icsA gene in the native strain was identical to the strains submitted in the gene-bank database. Since the pDS132::∆icsA contains 1484 bp derived from icsA gene, it can be used to disrupt icsA gene as a specific suicide vector.

Application of suicide systems facilitated mutant construction in more specific and effective methods in comparison with the other primary techniques such as serial passage.

One of the most important complications of tonsillectomy is laryngospasm which leads to airway obstruction, arterial hypoxemia, and hypercarbia. Thus the present study was carried out to compare the effect of propofol with sodium thiopental, as an induction agent of anesthesia, on the incidence and intensity of laryngospasm after extubation in tonsillectomy. This double-blind clinical trial was done on 60 3-12-year-old patients who were chosen for elective tonsillectomy at Qods Hospital in Qazvin. The patients were randomly divided into two equal groups. Method of anesthesia was the same in these two groups except for the induction of anesthesia; one group received sodium thiopental and the other group received propofol. At the end of the operation, patients were extubated after the restoration of spontaneous respiration with adequate tidal volume and respiratory rate. Then the incidence and intensity of laryngospasm was evaluated. Data were analyzed by t-test, Chi-square, and Fisher's exact test using SPSS software. Overall, 83% of the patients in the sodium thiopental group and 93% of the patients in the propofol group did not develop laryngospasm and there were no statistical differences between the two groups in terms of the incidence and intensity of laryngospasm after extubation in tonsillectomy (P=0.535). As an induction agent in general anesthesia, propofol has the same effect as sodium thiopental on the incidence and intensity of laryngospasm after tonsillectomy.

Sodium arsenite has adverse effects on the reproductive system and vitamin E is a strong antioxidant and reproductive factor in the reproductive system. The aim of this study was to investigate the effect of vitamin E on the structure and the number of ovarian follicles during its development in rats treated with sodium arsenite.

Pregnant Wister rats (n=4) were divided into 4 equal groups, including control, vitamin E (100mg/kg/day), sodium arsenite (8mg/kg/day), and sodium arsenite+vitamin E. Oral treatment of the pregnant rats started from the 7th day of pregnancy till the end of the weaning and continued till the age of 120 days. After the treatment period, the right ovary was removed and fixed, and then the mean number of ovarian follicles and atretic follicles, mean thickness of zona pellucida, and volume of oocytes and its nuclei in different types of follicle were determined. Data were analysed using one-way ANOVA and the mean difference was considered significant at P<0.05.

In the vitamin E+sodium arsenite group, significant increase(P<0.05) in the total number of follicles, mean number of primordial, primary, secondary, antral, and graafian follicles, significant reduction (P<0.05) in atretic follicles, and significant increase(P<0.05) in the thickness of zona pllucida in secondary and antral follicles as well as oocyte volume in parimordial and primary follicles and its nuclei in primary, secondary, antral, and graffian follicles were observed in comparison with the other groups. Vitamin E in the sodium arsenite+vitamin E group increased the number of different types of follicles and the thickness of the zona pllucida (P<0.05), decreased the number of atretic follicles, and increased the volume of oocyte and its nuclei to the level of the control group.

Vitamin E can be administered as a supplement to compensate for the adverse effects of sodium arsenite.

Several studies have demonstrated that the levels of inflammatory markers in healthy women are under the influence of menstrual cycle changes. The aim of this study was to compare blood levels of inflammatory markers in women with appendicitis in different phases of menstrual cycle.

In this case-control study, 70 female and 12 male patients with appendicitis, and 61 healthy women were enrolled based on inclusion and exclusion criteria. Inflammatory markers, such as leukocyte count, CRP, ESR, and TNF-α were measured and compared using student t-test and one-way ANOVA based on different phases of menstrual cycle.

There were no significant changes in the ESR, CRP, and TNF-α concentrations and the number of peripheral blood leukocytes in different phases of the menstrual cycle in women with appendicitis. The mean number of leukocytes and CRP concentrations were significantly higher in patients with appendicitis compared with the control group.

The findings show that there are not significant differences in the inflammatory markers in women with appendicitis during the different phases of menstrual cycles. It seems that day to day variation of sexual hormones in the menstrual cycle have led to very different conclusions about the change of inflammatory markers in different phases of menstrual cycle. Therefore, studies investigating inflammatory markers in women with acute appendicitis based on day of menstrual cycle, time of sampling in the day, and severity of appendicitis are suggested.

Since researchers were able to produce dendritic cells (DCs) from peripheral blood monocytes, many scientists have been in search of discovering the best way of producing dendritic cells and optimizing the DCs maturation processes in vitro to treat some diseases. The aim of this study was to investigate the maturation of DCs for tumor immunotherapy. In this experimental study, DCs were produced in two stages. In the first stage, monocyte cells were converted to immature DCs by GM-CSF and IL-4. In the second stage, immature DCs were made mature in the presence of human umbilical vein endothelial cells and PHA -activated T lymphocytes conditioned media and maturation factors. The produced DCs with appropriate phenotype, phagocytosis ability, and proliferation of T lymphocytes stimulation traits could secrete high levels of cytokines. Endothelial cells and T lymphocytes conditioned media can produce Th1 and DC1 in vitro. Therefore, DCs produced through this method are suitable for immunotherapy treatment applications and cancer treatment through treatment cells.

Gastric cancer is a common and lethal disease throughout the world. This study was designed and carried out to determine the five-year survival rate of gastric cancer patients who had undergone surgical treatment at Taleghani Hospital of Tehran, and to assess its associated factors. In this historical-cohort study, information obtained from a total of 213 gastric cancer patients who underwent surgery at Taleghani Hospital of Tehran between 2003 and 2008 was included. In the analyses, Kaplan-Meier method, log-rank test, Cox proportional hazards model, and Lin-Ying additive hazards model were used. The five-year survival rate and the median life expectancy in the studied patients were 14.6% and 29.6 months, respectively. Two covariates showed significant impacts on the gastric cancer patients’ data in both models: age at diagnosis and tumor size. We found that pathologic stage was significant under the Lin-Ying model (P=0.043); however, it was not significant under the Cox model (P=0.069). Other clinicopathological characteristics were not statistically significant (P>0.05). Since Cox and Lin-Ying models consider different aspects of the association between risk factors and the study outcome, it seems desirable to use both of them as complementary models but not as alternative models to obtain a more comprehensive understanding of data. This study showed that the early detection of patients in younger ages and in primary stages is important to decrease the risk of death in patients with gastric cancer and to increase the survival rate.

H. pylori infection is common worldwide involving 50% of the general population. The aim of this study was to compare the effect of two sequential regimen therapies on the eradication of H. pylori.

In this clinical trial, 150 patients were allocated to two groups of 75 each: group A and group B. The eradication of H. pylori in groups A and B was based on azithromycin and ofloxacin sequential regimens, respectively, and the results were compared between the groups. The data were analyzed by t-test, Chi-square test, and Fisher’s exact test using SPSS software version 16.

Mean of the patients’ age was 39.3± 1.2 within the age range of 18 to 85 years. There were not significant differences between the two groups considering the type of peptic ulcer. In group A, Urea Breath Test (UBT) was negative in 67 (89.3%) patients while in group B, it was only positive in 8 (10.7%) patients. In group B, there were 64 (85.3%) negative and 11 (14.7%) positive UBT test results. There were no significant differences in H. pylori eradication rates between the two groups (P=0.31).

Noticing the absence of a significant difference between the two groups in terms of H. pylori eradication, it can be concluded that ofloxacin-based drug regimens have no superiority over azithromycine-based regimens and each regimen can be prescribed considering drug complication rates in different patients.

Nowadays, cancer is one of the main causes of death in the world and mutagens cause death in millions of patients. Noticing the side effects of the drugs used to treat cancer, scientists are looking for drugs with fewer side effects and more therapeutic effects. Accordingly, the number of studies in this field is rapidly increasing. This study was done to evaluate the effects of antimutagenesis of aqueous and alcoholic extracts of A. vera leaf gel and latex by Ames test against the mutagenic substance named sodium azid in the presence and absence of microsomal homogenates of rat liver (S9). In this experimental study, after preparing different extracts of A. vera gel and latex, the antimutagenic effect of different extracts was assessed by Ames test, within which a mutant strain was grown on a culture containing mutagen substance (NaN3). Antimutagen (A. vera extract) reduced reversed mutation. The difference between the mean number of revertants per plate in relation to the mutagens was analyzed through one-way ANOVA using SPSS software. The results showed that the ethanol extract of latex and aqueous extract of gel had the maximum (91%) and minimum (56%) percentages of inhibition, respectively. This assessment revealed strong antimutagenicity effect for all of the extracts due to the presence of different kinds of antioxidants substances such as various anthraquinones, flavonoids, and vitamins A, C, and E. The maximum inhibition of mutation was observed in ethanol extract of latex. This observation supports the results obtained from the application of microsome mixture as well as those reported by other researchers.

Mindfulness and emotion regulation have important effects on the variables related to mental health in chemical weapons victims. The purpose of this study was to examine the effectiveness of mindfulness-based stress reduction and emotion regulation training on the affect and mood in chemical weapons victims.

This interventional study was conducted with two experimental groups and a control group including 47 male chemical weapons victims with high scores on the General Health Questionnaire in Sardasht city, Iran, randomly selected and then assigned to mindfulness training, emotion regulation training, and control groups. Mindfulness-based stress reduction (MBSR) training was used with experimental group 1, emotion regulation (ER) training was implemented with experimental group 2, and the control group received no training. Data were gathered using the General Health Questionnaire, Positive and Negative Affect and Depression-Happiness scales. Analysis of variance with repeated measure was used for analyzing the data.

The results indicated that mindfulness-based stress reduction and emotion regulation training significantly increased positive affect and mood and decreased negative affect in chemical weapons victims.

The results supported the effectiveness of mindfulness and emotion regulation training on affect and mood in chemical victims. Therefore, attention to the effectiveness of mindfulness and emotion regulation on variables related to mental health is important in chemical weapon victims.

Mucopolysaccharidoses disease type VI (MPS-6) or Marteaux-Lamy syndrome is an autosomal recessive lysosome storage disease which is caused by aryl sulfatase B enzyme deficiency. Because of the accumulation of abnormal metabolites in various tissues of body due to enzyme deficiency, different clinical manifestations from mild to severe occur in the patients. Case: This study reports a case of mucopolysaccharidoses disease admitted with fever, dyspnea, and pneumonia. The patient had coarse facial features, protruding tongue, dwarfism, and abdominal distension. In the urine sample, a significant amount of drmatan sulfate metabolite was found and peripheral blood smear testing indicated large and abnormal inclusions in peripheral blood neutrophils. Leukocyte aryl sulfatase B activity decreased and spine radiography reported multiple skeletal abnormalities. Differential diagnosis with other mucopolysaccharidoses indicated Marteaux-Lamy.