مجله دانشکده پزشکی اصفهان
پیاپی 276 (هفته اول اردیبهشت 1393)

The prediction of death in intensive care units is done by using scoring systems assess the disease severity. This study was performed to compare two scoring systems, Acute Physiology and Chronic Health Evaluation (APACHE) IV and Simplified Acute Physiology (SAPA) III, in predicting mortality rate in intensive care units (ICU).

In this retrospective cross-sectional study, we calculated 60 patient during the year 2012 admitted to ICU wards in Shahid Rajaei hospital, Qazvin, Iran. APACHE IV and SAPA III scores and predicted mortality were calculated. Then, the real mortality in intensive care units were recorded. Using the area under the curve of receiver operating characteristic (ROC), performance and differentiation of these models to predict mortality were assessed. Data were analyzed using Mann-Whitney test at the significant level of P-value of less than 0.05.

Of 74 patients admitted to the intensive care unit, 60 were included in the study, 38 men and 22 women. The mean age of patients was 59.0 years and the average duration of hospital staying was 12.10 days; 11 patients died. The mean scores of APACHE IV and SAPA III were 30.0 ± 3.4 and 15.0 ± 2.0, respectively. The area under ROC curve was 0.990 for APACHE IV with confidence interval of 0.930 to 1.008 and 0.97 for SAPA III with confidence interval 0.97-1.008with a significant difference (P < 0.001).

Our study revealed that APACHE IV scoring method predicted the mortality rates in intensive care units better than SAPSIII method.

The effect of various agents on neural stem cells differentiation, because of their ability to use in neurodegenerative diseases, has been widely considered. In this study, the effect of selegiline on mouse neural stem cells differentiation was evaluated. Neural stem cells were isolated from the subventricular zone of the brain of male C57 mice (2-3 months of age). To assay the effect of selegiline on neural stem cells differentiation into neurons, astrocytes and oligodendrocytes, immunocytochemical techniques were utilized. Neural stem cells were exposed to different concentrations of selegiline (nano to micro Molar) for 7 days. Subsequently, samples were exposed to specific antibodies against neurons (β tubulin), astrocytes (Glial fibrillary acidic protein or GFAP) and oligodendrocytes (Oligodendrocyte-specific protein or OSP). The differentiated cells were counted and reported as percent of total cells. Selegiline increased the β tubulin positive cells (0.001 to 0.1 μM) and decreased the GFAP positive cells (1 μM) compared to vehicle treated neural stem cells. We found that selegiline increased the differentiation of neural stem cells into neurons. Therefore, selegiline may be a reasonable choice to use in preparation of neural stem cells for transplantation.

Medullary thyroid carcinoma is a malignant tumor originated from parafollicular cells. Osteocalcin (OC) is the most non-collagenous protein in bone and its gene is located on chromosome 1 (1q25-q31). Important polymorphism in promoter region of osteocalcin gene is located at 298nt (rs1800247), in which C base is converted to T base. In this study, to evaluate the presence of this polymorphism with existence of medullary thyroid carcinoma (MTC), the rs1800247 polymorphism in promoter region of osteocalcin was studied.

In a case-control study, we evaluated the single nucleotide polymorphism (SNP) of rs1800247 in osteocalcin gene promoter in 200 volunteers, including 100 cases and 100 controls, consist of 106 men and 94 women. The mean age was 35.0 ± 11.3 and 37.0 ± 13.8 years in patients and controls, respectively. Thyroid biopsies and pathology confirmation were considered as confirmation of the medullary thyroid carcinoma diagnosis. Genomic DNA was extracted from the leukocytes using the standard Salting Out/Proteinase K method. Polymorphism detection was performed by polymerase chain reaction-sequencing (PCR-sequencing) and direct DNA sequencing methods. Obtained results were statistically analyzed using logistic regression method. The confidence level considered at 95%.

In patients’ population, the genotype frequency was 7%, 48%, and 45% for CC, TT, and CT, respectively; these amounts were 8%, 55%, and 37% in controls, respectively. The frequency of C allele was 29.5% in patients 35.5% in controls; and the frequency of T allele frequency was 70.5%, and 64.5% in patients and controls, respectively. There was not any statistically significant difference between the groups in any of the cases.

There was no association between the single nucleotide polymorphism of rs1800247 in promoter region of osteocalcin gene in patients with medullary thyroid carcinoma compared with normal individuals. According to no difference between allelic and genotypic frequencies between patients and controls, the mentioned polymorphism is not suitable candidate for genetic diagnosis of medullary thyroid carcinoma.

The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire for Colorectal Cancer (EORTC QLQ-CR29) is developed to specifically evaluate the quality of life in patients with colorectal cancer. In this study, we aimed to validate the QLQ-CR29 in Iranian patients with Persian language linguistically and to determine its psychometric properties.

This was a linguistic validation study. The QLQ-CR29 was translated by standard forward-backward translation method. After a pilot study with 15 patients, 100 patients with colorectal cancer completed the QLQ-CR29 along with the EORTC QLQ-C30 and the MD Anderson Symptom Inventory (MDASI) and the psychometric properties of the QLQ-CR29 were evaluated.

A hundred of patients with colorectal cancer participated in the main study with the mean age of 60.4 ± 13.4 year; 64% were men. Cronbach’s alpha was 0.89 for the whole QLQ-CR29 and ranged from 0.65 to 0.98 for the subscales. In all the multi-item subscales, the correlation of the item with its corresponding subscale was above 0.4 (r = 0.7 to 0.9). There was a moderate to strong significant correlation between the functional subscales of the QLQ-CR29 and the QLQ-C30 subscales (r = 0.3 to 0.6). In addition, most of the QLQ-CR29 subscales were correlated with MDASI severity and interference subscales (r = 0.2 to 0.5).

According to these results, the psychometric properties of the Persian version of the EORTC QLQ-CR29 are acceptable in Iranian society. This questionnaire can be applied for more precise evaluation of quality of life in patients with colorectal cancer in the future studies.

10 to 35% of the adult population all round the world is infected with nonalcoholic fatty liver disease (NAFLD). So far, no cure is recommended for this disease. Omega-3 fatty acids have beneficial effects in the treatment of hyperlipidemia and cardiovascular disease; the resort is recently used for the treatment of nonalcoholic fatty liver disease. The aim of this study was to review the studies about the role of omega-3 fatty acids on the prevention and treatment of nonalcoholic fatty liver disease.

First, PubMed and ISI databases were searched for the papers in their text there were the words NAFLD, NASH, nonalcoholic fatty liver, steatosis, DHA, EPA, fish oil and omega 3. Then, the papers were divided into tree groups: animal studies, cross-sectional studies, and case-control studies and clinical trials. Totally, 21 articles were evaluated.

The results of cross-sectional and case-control studies were not similar, but more robust studies showed that inadequate intakes of dietary sources of omega-3 was associated with fatty liver disease. Most interventions have been conducted in animal and human studies that have been reported positive effects of omega-3 supplementation in reducing triglycerides and fatty liver in patients with nonalcoholic fatty liver.

According to the available evidence, it seems that reduction of omega-3 food sources due to poor eating habits can be one of the reasons of multi-factorial fatty liver disease. In addition, the use of omega-3 supplement along with modification of the diet pattern and lifestyle is beneficial for patients.