Acute macular neuroretinopathy and COVID-19 vaccination: Case report and literature review

OBJECTIVE

To review cases of acute macular neuroretinopathy (AMN) after COVID-19 vaccination and add a similar case to the literature.

METHODS

A thorough PubMed search was conducted, and data from studies describing AMN after COVID-19 vaccination were extracted, tabulated, pooled, and reviewed.

RESULTS

We present a case of AMN in a young woman 5 days after immunization with the BBIBP-CorV (Sinopharm) COVID-19 vaccine. Data from 21 cases were pooled and reviewed. The most frequent vaccines among the cases were recombinant ones (13/21), followed by mRNA-based (6/21) and inactivated vaccines (2/21). Only one patient (5%) was male. Seventeen over twenty-one (81%) were young women, ages 18-33. Most cases (14/21; 67%) reported recent/concurrent use of contraceptive medication. In 90% of cases (19/21), symptoms appeared within 8 days of vaccination. A confined wedge-/oval-shaped lesion morphology was more frequent than a diffuse, semilunar one. Resolution of symptoms took 4 to over 15 weeks.

CONCLUSION

Attention should be paid to the history of vaccination and contraceptive use in patients with sudden-onset visual symptoms. Optical coherence tomography is integral to the detection of AMN-related abnormalities.

Natural history of subclinical hypothyroidism and prognostic factors for the development of overt hypothyroidism: Tehran Thyroid Study (TTS)

OBJECTIVE

The significance of subclinical hypothyroidism (SCH) is largely due to its potential risk for developing overt hypothyroidism (OH). Investigations are still exploring predictive factors contributing to the progression of SCH to OH, particularly in patients with mildly elevated serum thyrotropin (TSH). We aimed to clarify the natural history of SCH and the predictive factors of its progression, based on the grade of SCH severity.

METHODS

This study was conducted within the framework of the Tehran Thyroid Study (TTS), in which 5783 individuals aged ≥ 20 years were followed. After applying exclusion criteria, data of 270 SCH subjects remained for the analysis. Thyroid function tests were assessed at baseline and every 3 years.

RESULTS

Of 270 participants with SCH, 239 (88.5%) had TSH level between 5.06 and 10 mU/L, and 31 (11.4%) had TSH ≥ 10 mU/L. During a median follow-up of 10 years, 40% had TSH within the reference range, 44% maintained elevated TSH, and 16% had added low T4 to the elevated TSH. The annual incidence rate of progression to OH was 22.3 (16.5-101.9) per 1000 person-years [18 (12.6-25.6) for those with TSH 5.07-9.9 mU/L and 57.8 (22.8-101.9) for patients with TSH ≥ 10 mU/L per 1000 person-years (P = 0.001)]. After adjusting age, sex, body mass index (BMI), thyroid peroxidase antibody (TPOAb), and serum TSH, only TPOAb positivity (HR: 2.31; 95% CI 1.10-4.83, P = 0.026) and baseline TSH level ≥ 10 mU/L (HR: 5.14; 95% CI 2.14-12.3, P < 0.001) remained as predictors for development of OH. In patients with TSH 5.07-9.9 mU/L, TPOAb positivity was associated with an increased risk of OH (HR: 2.41; 95% CI 1.10-5.30, P = 0.027). However, in patients with TSH ≥ 10 mU/L, TPOAb positivity was not a predictor (P = 0.49).

CONCLUSION

TPOAb and not TSH are associated with the development of OH in individuals with serum TSH below 10 mU/L, and follow-up at regular intervals is recommended in TPOAb-positive individuals with TSH between 5 and 10 mU/L.

New perspectives of quercetin and vitamin C effects on fibronectin-binding integrins and chemokine receptors in prostate cancer cell lines

OBJECTIVES

The aim of this study is to investigate the effect of two abundant dietary supplements, quercetin and vitamin C on some factors involved in metastasis and proliferation of prostate cancer, which are resistant to conventional chemotherapies in late stages.

BACKGROUND

Bone and brain are two common sites of metastases in prostate cancer, nevertheless the factors involved in their metastatic pathways are not well understood.

METHODS

The effect of quercetin (75µM) and vitamin C (100 µM) on CXCR4, CXCR7 chemokine receptors, α4, α5 and β1 integrins, ki-67 proliferation marker and Vascular endothelial growth factor, VEGF was evaluated using Quantitative Reverse Transcription PCR (RT-qPCR).

RESULTS

The effect of quercetin and vitamin C alone was different on PC3 and DU145 prostate cancer cell lines, but sequential combination reduced significantly the expression of CXCR and CXCR7 chemokine receptors, α4, α5 and β1 integrin subunits, VEGF and Ki-67 proliferation markers in PC3 and DU145 cell lines.

CONCLUSION

Our results indicated the beneficial effect of quercetin and vitamin C on prostate cancer cells with different metastatic sites and their differential response to the treatment which in turn may lead us to reach suitable therapeutic outcomes to combat cancer (Fig. 3, Ref. 36).

Liver Transplantation in Hepatocellular Carcinoma: Experiences from the Shiraz Transplant Center

BACKGROUND

Studies evaluating liver transplantation (LT) in hepatocellular carcinoma (HCC) in the Middle East have been scarce, mainly due to intricacy of this type of surgery.

OBJECTIVE

In here we report our experiences with LT among patients with HCC cirrhosis.Methods: All patients who underwent LT with primary diagnosis of HCC older than 18 years old, during 2004 to 2019, were initially included in our study.

RESULTS

Overall, 124 patients entered our study, among which majority were males (86.3%). Mean (SD) age of patients was 53.1±10.6 years old. Most common underlying liver diseases were HBV (55.6%) and HCV infections (12.1%). Mean MELD score of patients was 18±5.5. Child-Pugh score of most patients was class B (50%). Mean (SD) duration of hospitalization was 12.1±3.5 days. Patients were followed for a median of 32 (9, 62) months. The most common causes of death were recurrence of HCC (47.7%) and sepsis (34.1%). Median (IQR) duration to recurrence and death were 18 (4, 34) months and 17.5 (5.7, 44.5) months, respectively. One-year survival (89%, 86.4%, and 63.2%, respectively) (p=0.011) and one-year DFS (89%, 86.4%, and 57.9%, respectively) (p=0.001) was significant different between those who were selected based on the Milan, UCSF and extended criteria.

CONCLUSION

Our study provides valuable experiences on LT and HCC from one of the largest LT centers in the world. Accordingly, we found that the Milan criterion provides the best survival compared to the UCSF and our extended criteria for patient selection.

TET2, DNMT3A, IDH1, and JAK2 Mutation in Myeloproliferative Neoplasms in southern Iran

BACKGROUND

Five epigenetic regulator mutations are considered in myeloproliferative neoplasms (MPN) that have prognostic and therapeutic values.

OBJECTIVE

We aimed to evaluate these mutations in MPNs among the Iranian population.

METHODS

We selected 5 mutations in 4 epigenetic regulatory genes [TET2, DNMT3A, IDH1 (rs147001633&rs121913499), and JAK2)] and evaluated 130 patients with MPNs including 78 Philadelphia chromosome negative (49 ETs, 20 PVs, and 9 PMFs) and 52 Philadelphia chromosome-positive patients as well as 51 healthy controls.

RESULTS

Eight patients (6.5%) carried the DNMT3A mutation, 35 (27%) were positive for TET2 mutation and 64 (49.3%) had the JAK2V617F mutation. In the healthy controls, 16 (31.4%) cases had the TET2 mutation (15 Heterozygote + 1 Homozygote) and one had heterozygote JAK2 mutation. There was no statistically significant difference between patient groups for any of these mutations, except for JAK2. The JAK2 mutation rate was 18 (90%), 25 (51%), 7 (77.8%), 14 (26.9%) in polycythemia vera, essential thrombocythemia, primary myelofibrosis, and chronic myelocytic leukemia, respectively. Patients aged 60 and older were more likely to carry the TET2 mutation (23% vs. 39% in younger and older than 60 years old individuals, p=0.025). IDH1 was not detected at all and PV had the highest TET2 mutation 7(35%). Two PMF patients had a history of bone marrow transplantation that were negative for IDH1and DNMT3A and one was positive for TET2 mutation.

CONCLUSION

In the normal Iranian population, the heterozygote form of TET2 mutation is significant, especially in the elderly. No association was found between JAK2 and TET2 mutations. Both of them are more prevalent in the age group of 60 years and older. DNMT3A mutation has a low prevalence and occurs in both positive and negative MPNs.

Attitudes of nurses towards clinical information systems: a systematic review and meta-analysis

AIM

This systematic review and meta-analysis evaluates the attitudes of Iranian nurses towards clinical information systems in nursing practice.

BACKGROUND

Nurses are essential in the successful adoption and implementation of clinical information systems.

METHODS

A systematic search was performed in Medline, Embase, Cochrane, CINAHL, Scopus, and Web of Science and Farsi databases, to retrieve relevant studies. The methodological quality of the studies is assessed via the Joanna Briggs Institute's critical appraisal checklist for analytical cross-sectional studies. The random effect model was utilized to analyse the data due to the high heterogeneity in the included studies (n = 17).

RESULTS

Results indicate that clinical information systems impact on at least seven aspects of nursing practice, including documentation, patient safety, quality of treatment, communication, treatment management, nursing tasks and hospital resource management. Results also indicated that one aspect of using clinical information systems in nursing practice is satisfaction with the 'quality and design of clinical information systems', such as ease of use and learning, flexibility and software speed.

CONCLUSION

Clinical information systems can contribute to different aspects of nursing practice. However, their design should improve significantly in order to help nurses perform their professional activities in an efficient and satisfactory manner.

IMPLICATIONS FOR NURSING POLICY

Before the full deployment of clinical information systems, their usability should be tested. In pilot testing, nurses should provide necessary feedback about how well the systems work and improvements needed to meet their professional goals.

Comparison of Human Mesenchymal Stem Cells Derived from Various Compartments of Human Adipose Tissue and Tunica Adventitia Layer of the Arteries Subsequent to Organ Donation

BACKGROUND

Mesenchymal stem cells are one of the most interesting cell sources used in regenerative medicine.

OBJECTIVE

In the present study, we isolated and characterized the mesenchymal stem cells from various compartments of human adipose tissue and tunica adventitia layer of the arteries.

METHODS

Tissue explant culture was done from various compartments of the human adipose tissue and tunica adventitia layer of the arteries, including adipose tissue far from the vessels, perivascular tissues that are completely attached to the vessels, and tunica adventitia layer of the arteries. After the cell culture, characterization of the cells was determined at 3^rd-5^th passages. Flow cytometry was performed for antigen expression analysis of CD34, CD45, CD44, CD90, CD29, CD73, and CD105. For the evaluation of cell differentiation potential, adipogenic and osteogenic differentiation was conducted under appropriate protocols.

RESULTS

The cells were positive for CD44, CD90, CD29, and CD73 and negative for CD34, CD45, and CD105. Adipogenic and osteogenic differentiation potentials were different among the cells from various compartments. The cells derived from perivascular tissue demonstrated better adipogenic and osteogenic differentiation.

CONCLUSION

It is essential to characterize the cells from different tissues and compartments for different purposes in regenerative medicine.

The Effects of Cold Preservation Solutions Supplemented with UDCA and α-Lipoic Acid on the Viability and Function of Isolated Human Hepatocytes

BACKGROUND

Liver transplantation is the only treatment for end-stage and genetic liver diseases. The main burden of this treatment is the shortage of both living and cadaveric liver donors. An alternative treatment is using liver cell transplantation, which can be obtained from unused livers for transplantation. These hepatocytes should be kept ready in viable and functional situation in a frozen state to be instantly used when they would be needed. In our previous experience, we had isolated hepatocytes from unused livers.

OBJECTIVE

To find a preserving solution for increasing viability and function of the isolated hepatocytes that are stored to be transplanted.

METHODS

9 cadaveric donor livers, which were not used for transplantation due to various causes such as severe steatosis, were selected to isolate hepatocytes. Various cold storage solutions were tried to find the best temperature for more viability and functionality for preservation of hepatocytes. University of Wisconsin (UW) solution and Williams E media were used as control media. 2 anti-apoptotic and anti-oxidative solutions, i.e., α-lipoic acid and ursodeoxycholic acid (UDCA), were used as cold preservatives solutions. The numbers of viable hepatocytes were estimated by trypan blue method; the functionality was assessed by the cells ability to produce urea.

RESULTS

The highest number of viable and functional hepatocytes was obtained from freshly isolated cells. However, after preservation, the number of these viable hepatocytes and their functionality were not significantly different in cold storage solutions comparing to the control media used. Functionality of the isolated hepatocytes stored in UW with and without UCDA solution was similar to freshly isolated hepatocytes.

CONCLUSION

Preservatives with anti-apoptotic and antioxidant activity could not increase the number of viable hepatocytes. Functionality of cold storing hepatocytes could be preserved similar to freshly isolated hepatocytes by UW solution with and without UCDA.

A solution for enhancement of transient performance in nonlinear adaptive control: Optimal adaptive reset based on barrier Lyapunov function

In this paper, an adaptive controller based on barrier Lyapunov function combined with an optimal reset rule is devised in order to improve the transient performance of nonlinear adaptive control. A novel reset rule is designed such that the estimated parameters of the adaptive controller jump to the optimal values in a way that optimizes a cost function representing the transient performance index. It is proved that asymptotic tracking is achieved and the output remains in a desired bound by ensuring boundedness of the barrier Lyapunov function. Besides, the convergence rate is increased by resetting the estimated parameters to optimal values. A regularly referred example is simulated to demonstrate the effectiveness of the proposed method and the results are compared with the existing investigations.

Intrathecal Autologous Bone Marrow-Derived Hematopoietic Stem Cell Therapy in Neurological Diseases

BACKGROUND

Cellular transplantation is a promising treatment strategy for neurological diseases.

OBJECTIVE

To report the results of intrathecal hematopoietic stem cell therapy in different neurological diseases in the past 6 years in a single center.

METHODS

From October 2011 to September 2018, 220 patients with various neurological diseases were transplanted intrathecally by their bone marrow stem cells. To have a longer follow up, we only reported the first 80 patients, transplanted up to July 2015-10 patients had spinal cord injuries and paralysis, 12 had advanced Parkinson's disease, 28 had cerebral palsy, 7 had hypoxic brain damage, 2 had autism, 4 had multiple sclerosis, 5 had progressive cerebellar atrophy, and 12 had other neurological diseases. The patients were admitted to the Bone Marrow Transplant Unit. On the first day, 50-200 (median 100) mL bone marrow was aspirated from the patients' posterior iliac crests, mixed with 120 mL culture media (RPMI), and 12 mL heparin. The samples were then transferred to immunology lab in cold box. Mononuclear cells (MNCs) were separated by a Ficoll-Hypaque gradient, washed, and suspended in ringers. Cell viability was assessed with trypan blue viability test. Transplantation was performed 3-4 hours after bone marrow collection. 5-10 mL of the cerebrospinal fluids were aspirated and about 20 mL MNCs (containing stem cells) in ringers were injected intrathecally (IT). The patients were laid down on their back for 4-5 hours. The median number of MNCs was 4×10⁷ (range 1-450×10⁷). The median viability of the cells was 90% (range 60%-98%). The patients received intravenous ceftriaxone every 12 hours and were discharged from the hospital few days after autologous stem cell therapy.

RESULTS

We noted clinical improvements in 9 of 12 patients with Parkinson's disease, 20 of 28 patients with cerebral palsy, 6 of 7 patients with hypoxic brain damage, 2 of 4 patients with multiple sclerosis, and 4 of 5 patients with cerebellar atrophy. The improvements were noted after 2-4 weeks of cell therapy. There were no improvements in patients with spinal cord injury and complete paralysis and those with autism. There were variable improvements in other patients treated.

CONCLUSION

Most patients with advanced Parkinson's disease, cerebral palsy, hypoxic brain damage, progressive cerebellar atrophy, and kernicterus neuropathy reported clinical effects of this safe intervention resulting in better functioning and an increased quality of life.

Awareness of Religious Leaders' Fatwa and Willingness to Donate Organ

BACKGROUND

It is believed that religious leaders' positive attitude towards organ donation can be an effective factor in Muslims' inclination to donate organs.

OBJECTIVE

To assess the knowledge of freshmen students in Mashhad University of Medical Sciences about religious leaders' fatwa on organ donation and its effect on their willingness to donate organs.

METHODS

This cross-sectional study was conducted in 2013 on 400 freshmen of various medical disciplines, selected using a simple random sampling in Mashhad, Iran. Data were collected by a valid and reliable researcher-made questionnaire. Data were analyzed by multiple logistic regression analysis.

RESULTS

41.5% of the students were aware of religious authorities' views on organ donation and 55.6% were willing to donate organs. Participants' main reasons for lack of willingness to donate organs included the fear of organ donation before the brain death is confirmed (52%), unwillingness to disfigure their body (51%), and belief in the burial of organs (50%). The willingness to organ donation for students who were aware of religious leaders opinion was more than twice more than those who were not (OR: 2.56, 95% CI: 1.75-4.52). Also, female gender, the Shia religion and awareness of the correct definition of brain death were associated factors affecting the desire to donate organs, although their effects were not statistically significant on regression model.

CONCLUSION

A considerable proportion of students were not aware of the religious leaders' fatwa on organ donation. The most important factor for the desire to donate organs was the awareness of religious leaders' fatwa. Therefore, it seems necessary that religious leaders' fatwa be known to all by appropriate methods.

Clinical outcome, and survival between primary percutaneous coronary intervention versus fibrinolysis in patients older than 60 years with acute myocardial infarction

OBJECTIVE

The aim of the present study was to compare the short-term and 6-month clinical outcome, and survival in patients older than 60 years with ST-elevation myocardial infarction randomized to either primary percutaneous coronary intervention (PPCI) or thrombolysis.

MATERIALS AND METHODS

82 patients with STEMI older than 60 years were randomized to either primary PCI or thrombolysis from September 2006 to August 2008. Angiograms were reviewed by two interventionalists not involved in the study. Patients randomized to primary PCI received Aspirin and 600 mg Clopidogrel. Heparin was administered in conjunction with PCI. Patients randomized to thrombolysis received Aspirin followed by streptokinase infusion for one hour. Rescue PCI was considered if there was ongoing pain and ST-segment resolution was <50% at 90 min. after initiation of thrombolysis or chest pain recurred with ST-segment elevation within 24 hours. All patients were followed up for 6 months. End points were reinfarction and cardiac death using competing-risks regression estimation.

RESULTS

The mean time from hospital admission to start of streptokinase infusion was 31 ± 15 min and door to balloon time was 70 ± 25 min. There was no significant difference between the groups in the number of deaths and reinfarctions at 6 months. As expected, the fibrinolysis group had a higher rate of revascularization and heart failure.

CONCLUSION

The higher rates of heart failure and need for revascularization in the fibrinolysis group reinforces benefits of PPCI in patients older than 60 years. PPCI in those who are 60 years and above with AMI is safe and cost effective.

The molecular prevalence of viral infections in transplant candidates with bone marrow suppression, shiraz, southern iran, 2010

BACKGROUND

Transient bone marrow suppression, characterized by acute inability of the bone marrow to produce circulating blood cells, may strongly relate to the pathogenesis of some viral infections.

OBJECTIVE

To study the prevalence of some DNA and RNA viruses in patients with transient bone marrow suppression.

METHODS

EDTA-treated blood samples were collected from 27 patients with clinically- and laboratory-confirmed transient bone marrow suppression. The genomic DNA of hepatitis B virus, adenovirus, polyomavirus BK, and parvovirus B19, and genomic RNA of hepatitis C and G viruses were extracted and amplified by sensitive and specific in-house simple and nested PCR and RT-PCR protocols, respectively. The risk factors that might be related to the studied viral infections were analyzed.

RESULTS

Hepatitis B virus infection was diagnosed in 9 (33%) of 27 patients; adenovirus infection in 2 (7%); and parvovirus B19 infection in 7 (26%) of 27 patients. The genomic DNA of polyomovirus BK was not detected in any patients. Both hepatitis C and G viruses were found in 3 (11%) of 27 patients.

CONCLUSION

Diagnosis of the high prevalence of hepatitis B virus, and parvovirus B19 in patients with transient bone marrow suppression, reflects the importance of these viral infections in introducing bone marrow suppression. This hypothesis should be confirmed in further studies.

Hip circumference, height and risk of type 2 diabetes: systematic review and meta-analysis

Although several epidemiological studies have investigated the relationship between type 2 diabetes mellitus (T2DM) and hip circumference or height, the results are inconsistent. The present systematic review and meta-analysis of published observational studies was conducted to assess the effects of hip circumference and height on diabetes risk. Online databases were searched through January 2012, and the reference lists of pertinent articles reporting observational studies in humans were examined. Pooled relative risks (RR) and 95% confidence intervals (CI) were calculated with a random-effects model. Eighteen studies (nine cross-sectional and nine cohort) were included, with 250,497 participants and 7,765 cases of T2DM. Hip circumference was inversely associated with an increased risk of T2DM in men (summary RR [95% CI] 0.60 [0.45, 0.80]) and women (0.54 [0.42, 0.70]). These results were consistent between cross-sectional and cohort studies. An inverse association between height and T2DM was observed in women only (summary RR [95% CI] 0.83 [0.73, 0.95]). Our meta-analysis strongly supports an inverse relationship between hip circumference and risk of T2DM in men and women. The inverse association between height and risk was significant only in women.

Spouse-assisted training in pain coping skills and the outcome of multidisciplinary pain management for chronic low back pain treatment: a 1-year randomized controlled trial

This study examined the comparative efficacy of three interventions: a spouse-assisted coping skills training protocol for patients undergoing a multidisciplinary pain management programme (SA-MPMP), conventional patient-oriented multidisciplinary pain management programme (P-MPMP) and standard medical care (SMC). Thirty-six chronic low back pain (CLBP) patients and their spouses were randomly assigned to one of the three conditions. The SA-MPMP condition consisted of seven, weekly, 2-h, group sessions of training in dyadic pain coping and couple skills, delivered by a clinical psychologist with support of a multidisciplinary team of specialists, to patients together with their spouses. P-MPMP consisted of the SA-MPMP training delivered to the patient only (i.e., no spouse participation and assistance). The SMC condition entailed continuation of routine treatment, entailing medical care only. Data analysis revealed that, at the 12-month follow-up time point, patients receiving SA-MPMP had significant improvements in kinesiophobia and rumination about pain compared to those receiving P-MPMP and SMC. In patients suffering from CLBP, an intervention that combines spouse-assisted coping skills training with a multidisciplinary pain management programme can improve fear of movement and rumination about low back pain.

Modification of attentional biases in chronic pain patients: a preliminary study

Research suggests that chronic pain patients demonstrate cognitive biases towards pain-related information and that such biases predict patient functioning. This study examined the degree to which a successful cognitive-behavioural program was able to reduce the observed attentional bias towards sensory pain words. Forty-two patients with chronic pain conditions for more than three months were recruited prior to commencing a cognitive-behavioural pain management program. Participants were assessed before the program, after the program and at one-month follow-up. Results confirmed that chronic pain patients exhibited biased attention towards sensory pain-related words at pre-treatment. These biases were still evident at post-treatment, but were no longer statistically significant at follow-up. Multiple regression analyses indicated that the changes in attentional bias towards sensory words between post-treatment and follow-up were predicted by pre- to post-treatment changes in fear of movement (Tampa Scale for Kinesiophobia) but not other relevant variables, such fear of pain or anxiety sensitivity. These results demonstrate that successful cognitive-behavioural treatments can reduce selective attention, thought to be indicative of hypervigilance towards pain. Moreover, these biases appear to be changed by reducing the fear associated with movement. Theoretically, these results provide support for the fear of (re)injury model of pain. Clinically, this study supports the contention that fear of (re)injury and movement is an appropriate target of pain management and that reducing these fears causes patients to attend less to pain-related stimuli.

Two-year experience of orthotopic liver transplantation in afzalipoor hospital, kerman, southeastern iran

BACKGROUND

End-stage liver diseases are common in Iran. The only therapeutic option for these patients is liver transplantation.

OBJECTIVE

To present our 2-year experience of liver transplantations in Afzalipoor Hospital, Kerman, southeastern Iran.

METHODS

From November 2009 to September 2011, 12 patients underwent orthotopic liver transplantation in our center. Their data including demographics, indications for transplantation, MELD scores, post-operative complications and their management were collected.

RESULTS

Patients (7 women and 5 men) aged between 14 and 55 years. Indications for the transplantation included HBV infection (n=5), cryptogenic cirrhosis (n=2), Wilson's disease, alcoholism (n=1), HCV infection (n=1), Budd-Chiari syndrome (n=1), and autoimmune hepatitis (n=1). MELD score of patients ranged from 16 to 30. All patients received tacrolimus, mycophenolate mofetile and corticosteroid, postoperatively. 2 patients died of pulmonary and intra-abdominal infections with resultant to multiple organ failure. Nonfunctioning of transplanted liver and ongoing bleeding resulted in death in another patients. 9 patients are well doing and have excellent liver functions.

CONCLUSION

We had relatively successful results in our experience of orthotopic liver transplantation. Vicinity of our center to Shiraz Transplant Center would be an important factor in this success.

Molecular impact and inducible factors associated with adenovirus infection in hematopoietic stem [corrected] cell transplant patients

BACKGROUND AND PURPOSE OF STUDY

Latent and active adenovirus infections are detected in 5% to 20% of hematopoietic stem cell transplant (HSCT) patients. In addition to the significant role of adenoviral infection in the pathogenesis of late-onset hemorrhagic cystitis in HSCT patients, adenovirus infections may have possible roles in undefined posttransplant clinical complications. Therefore, pre- and posttransplantation we studied the prevalence and role of adenoviral infections among HSCT clinical syndromes using molecular methods.

MATERIALS AND METHODS

In this cross-sectional study between 2005 and 2008. We collected 470 EDTA-treated blood samples from 125 HSCT recipients, including 70 (56%) men and 55 (44%) women. The 52 (41.6%) HSCT patients underwent autologous grafts and the other 73 (58.4%), from related donors. One EDTA-treated blood sample was collected from all recipients pretransplantation. Also once per week for 3 months we were collected blood samples from HSCT patients to evaluate the prevalence of adenovirus DNA infection by a qualitative in house polymerase chain reaction method.

RESULTS

The adenovirus genome was diagnosed in 2/75 (2.7%) HSCT patient samples pretransplantation. There were 28/395 (7.1%) plasma samples of transplant patients infected with adenovirus DNA. Graft-versus-host disease (GVHD) clinical complications were observed in six adenovirus-infected transplant recipients; there was a significant correlation between these viral infections and GVHD clinical presentation.

CONCLUSION

The high prevalence of adenovirus infection in HSCT recipients pre- and posttransplantation, was significantly related to GVHD symptoms, enforcing the important pathogenic role of these viral infections in clinical complications post-HSCT.

Effects of electromagnetic fields on mental health of the staff employed in gas power plants, Shiraz, 2009

The aims of this study are to assess, in a power station in Shiraz, the effects of noise and electromagnetic field on psychological mood. By the great industrial and technological improvements human beings have been exposed to different types of physical and chemical factors. Some of these factors such as electromagnetism are known as the constant components of the environment. According to the studies carried out in one of the power stations in Shiraz, psychological disorders caused by jobs are among the most important problems of the workers. This study is performed to determine the presence or absence of these psychological disorders. This cross-sectional study is performed on these groups : (1) The gas power plant staff who were in contact with electromagnetic field and nose, (2) employees who were only exposed to noise and (3) a group of staff employed in the administrative parts of the Telecommunication companies who did not have any history of being exposed to electromagnetic field and sounds. The General Health Questionnaire (GHQ) is used in this study to recognize psychosomatic disorders. Measurements indicate that range of electromagnetic field varies from 0.087 micro Tesla in the phone homes to 30 micro Tesla in power stations. The results of this study has shown that a significant number of staff which were exposed to electromagnetic fields and noise (78.2%) were suspected to have a kind of mental disorders. The results obtained from this study which shows the prevalence of mental disorders among the suspected case is higher than the results of Noorbala and colleagues study in 2006.

Cesarean labor cognitive related variables in private and public hospitals

Introduction

Recent clinical reports show a sharp rise in the cesarean section rate, particularly in the private hospitals that might be affected by the cognitive variables.

Objectives

This research was to compare fear of pain, pain catastrophizing, catastrophic cognition and also childbirth attitude in private and public hospitals.

Aims

The main aim of this research was to compare fear of pain, pain catastrophizing, catastrophic cognition and also childbirth attitude in private and public hospitals.

Methods

Participants were (n = 150) pregnant women from private hospitals who were selected using available sampling method as well as (n = 150) pregnant women from public hospitals who were counter balanced on the basis of the age, education, previous number of deliveries, previous number of cesarean and type of hospital variables. Three questionnaires of fear of pain (FPQ) and catastrophic cognition (CCQ) and childbirth attitude (CAQ) as well as scale of pain catastrophizing (PCS) were administrated.

Results

Multivariate analyses of variance were shown significantly differences for two cognitive variables of “fear of pain” and “catastrophic cognition”, while no significant difference were observed for other variables.

Conclusions

These results suggested fear of pain and catastrophic cognition as important cognitive factors in the increase rate of cesarean labor in private hospitals.

A new classification for female infertility

Infertility is defined as the inability of a couple to conceive after 12 months of regular, unprotected intercourse. However infertility is a clinical presentation and not a disease. Thus to be able to offer a new classification, it is necessary to apply a clinical presentation (philosophy) suggested by the University of Calgary in 1991. In recent years several classification algorithms have been proposed which apply key predictors of clinical, imaging, or morphological types to determine the diseases that can cause infertility. On the other hand, an algorithm is a product of an expert's mind after many years of practice and experience, which is too difficult to understand by a medical student. However there has not been any simple schematic classification based on a logical justification applying integration of etiologies with basic science to break down etiologies into categories, subcategories and disease classes of this clinical presentation. Because etiology has also become an important criterion for the characterization of causes of infertility, a classification proposal is presented here that attempts to include all relevant (basic science) features of the causative diseases of this clinical presentation.

Nonlinear solution for radiation boundary condition of heat transfer process in human eye

In this paper we propose a new method based on finite element method for solving radiation boundary condition of heat equation inside the human eye and other applications. Using this method, we can solve heat equation inside human eye without need to model radiation boundary condition to a robin boundary condition. Using finite element method we can obtain a nonlinear equation, and finally we use nonlinear algorithm to solve it. The human eye is modeled as a composition of several homogeneous regions. The Ritz method in the finite element method is used for solving heat differential equation. Applying the boundary conditions, the heat radiation condition and the robin condition on the cornea surface of the eye and on the outer part of sclera are used, respectively. Simulation results of solving nonlinear boundary condition show the accuracy of the proposed method.

Effect of bright light on shift work nurses in hospitals

The aim of this study are to assess, in a hospital setting, the effects of Bright Light (BL) on the rhythms in body temperature, plasma melatonin, plasma cortisol and subjective alertness during shift work. In our experimental design, 34 healthy shift work nurses from a university hospital were exposed to bright light (4500 lux) during two break times (21:15 to 22; 00 and 3:15 to 4:00) for four consecutive weeks. In this survey, the subjects were studied under 24 h of realistic conditions during which their plasma cortisol and plasma melatonin was measured at 3 h intervals. In addition, their body temperatures were measured during and after night shift work. Subjective alertness and fatigue were evaluated with the Karolinska Sleepiness Scale (KSS) and Visual Analog Scale (VOI). It was found that bright light administration significantly suppressed nighttime melatonin levels during night shift, most strongly at 2:00 a.m. A one-way ANOVA, with repeated measurement design, revealed that Bright Light (BL) tended to increase cortisol levels and body temperature and improved alertness significantly during night shift. These results demonstrate that photic stimulation in a hospital setting can have a powerful influence on the adjustment of the circadian system.

The role and frequency of glutathione s-transferase P1 polymorphism in Iranian patients affected with reflux esophagitis

Reflux esophagitis is a common complication of the gastroesophageal reflux disease. Glutathione s-transferases (GSTs) have important role in the protection of cells from the products of oxidative stress. GSTP1*B allele has a correlation with susceptibility to several diseases. In this case-control study, the role and frequency of GSTP1 polymorphism was evaluated in Iranian patients with erosive reflux esophagitis. Seventy patients with erosive reflux esophagitis and 75 normal individuals were enrolled in this study. The grade of esophagitis was determined via endoscopy. DNA was extracted from venous blood of each subject using the salting out method. GSTP1 genetic polymorphisms were detected using the polymerase chain reaction restriction fragment length polymorphism method. There was a significant difference in GSTP1 genotype frequency between patients and normal groups (P= 0.006). Also, in the patient group, the grade B of esophagitis was significantly associated with variant GSTP1 genotype (P= 0.028). The rate of throat pain symptom was higher in the no-variant group (P < 0.036). The GSTP1*B allele frequency in Iranian normal groups is similar to Orientals. Reflux esophagitis are more commonly found in variant (*B/*B and *A/*B) GSTP1 genotypes. In addition, GSTP1 polymorphism is correlated with a higher grade of esophagitis.

The efficiency of Amberjet 4200 resin in removing nitrate in the presence of competitive anions from Shiraz drinking water

The aim of this research is to study the feasibility of removing nitrates from water by means of anion exchange. In the purposed work an attempt was made to utilize strong basic anion resin to remove nitrate in the presence of competitive anion. Amberjet Cl- 4200 ion exchange resin was used in a batch scale. The fixation rate of nitrate without the presences of any competitive anion was almost constant (94.60-96.43) when the nitrate concentrations are in the range of 100-150 mg L(-1). The fixation rate of nitrate in the presences of two competitive anions (sulphate and chloride) was reduced to 82% when the concentration of nitrate was 100 mg L(-1).

Assessment of atrazine distribution in Shiraz soils, south of Iran

The main objective of this study was focused on determining atrazine residual concentration in agricultural soil in Shiraz and its vicinity. Twenty two sampling fields were selected by grid sampling in Shiraz and its vicinity. Atrazine residual concentrations in 0-20, 20-40 and 40-60 cm soil depths were in the range of 15-550 microg kg(-1) soil. Data showed that the concentration of atrazine did not exceed the soil quality standard for agriculture which is 22 mg kg(-1) soil and there was no significant difference between depth and atrazine residual concentration (p > 0.05). Although, in all sampling regions in Shiraz and its vicinity, the concentration of atrazine did not exceed the soil quality standard for agriculture, atrazine leaching and dissipation rate in soil and risk of atrazine ground water pollution must be determined.

Assessment of the potential of scale formation and corrosivity of tap water resources and the network distribution system in Shiraz, South Iran

The aim of this research is to study the potential of scale formation and corrosivity of water resources and the network distribution system of Shiraz in Fars province, South Iran. The Langelier saturation index (LSI) was used to assess the scale formation and corrosivity. The index was calculated based on the principle of calcium deposition. This research was done through 118 water resources samples which include wells and surface water and many different points in the network distribution system during late Summer and early fall, 2007. The mean LSI value for all the samples was 0.417. Although, the results indicated the scaling potential in all water samples, monitoring the corrosion rates was done on a regular basis. Seasonal changes can affect water quality, and therefore the corrosion rates.

Liver transplantation for homozygous familial hypercholesterolemia: two case reports

Homozygous familial hypercholesterolemia (HFHC) is a rare inherited condition with an incidence of one in one million. It is associated with severe premature atherosclerosis and early death from cardiovascular complications. Mutation in the gene that encodes the synthesis of the cellular receptor for low-density lipoprotein (LDL) is responsible for this metabolic disorder. Currently, the only effective treatment for this disease is liver transplantation, which alone or in association with medications, normalizes plasma cholesterol level. The authors report the results of liver transplantation for two cases of HFHC. The first case, a 15-year-old boy received a whole liver from a deceased donor, and the second, an 11-year-old boy, received a left liver lobe transplant from his mother's sister. Their preoperative fasting lipid concentrations were grossly raised. The older boy had severe atherosclerotic heart disease and had undergone coronary artery bypass grafting 5 months before transplantation. Both had preoperative plasma cholesterol levels higher than 750 mg/dL with normal thyroid and liver function tests. After the operation, the patients received methylprednisolone as pulse therapy followed by oral prednisolone, mycophenolate mofetil, and tacrolimus for immunosuppression. Their hospital stays were 24 and 13 days, respectively. The first case needed reexploration because of bleeding on the second day after the operation. The lipid concentrations rapidly returned to the normal range in the first week after the operation, remaining in this range over the first 6 months of follow-up. Liver transplantation offers an highly effective treatment for HFHC. It is better to operate on patients before severe atherosclerotic changes in the coronary arteries. All patients must undergo a complete cardiac evaluation before surgery.

Liver transplantation in the presence of old portal vein thrombosis

BACKGROUND

Portal vein thrombosis (PVT) has been mentioned as a potential obstacle to liver transplantation (LTx).

OBJECTIVE

To review the impact of PVT on orthotopic liver transplant (OLT) outcome.

METHOD

Between January 2006 and April 2009, 440 OLT were performed in Shiraz Transplant Unit of whom, 35 (7.9%) cases had old PVT with recanalization. Data were retrospectively collected regarding the demographics, indication for OLT, Child-Turgot-Pugh classification, pre-transplant diagnosis of PVT, perioperative course and managements, relapse of PVT, early post-operative mortality and morbidity. All patients received liver from deceased donors, underwent thrombendvenectomy with end-to-end anastomosis without interposition graft and evaluated daily for 5 days and thereafter, biweekly by duplex sonography during the follow-up period for 2 months. They were treated by therapeutic doses of heparin followed by warfarin to maintain an INR of 2-2.5.

RESULTS

The causes of end-stage liver disease were hepatitis B in 11, cryptogenic cirrhosis in 11, primary sclerosing cholangitis in 5 and other causes in 8 recipients. Extension of thrombosis was through confluence of superior mesenteric and splenic vein in 32 and to superior mesenteric vein in 3 patients. The mean±SD operation time was 7.2±1.5 hrs. The mean±SD transfusion requirement was 5.4±2.8 units of packed cells. The mean±SD duration of hospital stay in these patients was 17.7±10.9 days. Eight patients died; 1 developed early in-hospital PVT, 1 had hepatic vein thrombosis, and 1 died of in-hospital ischemic cerebrovascular accident, despite a full anticoagulant therapy. The mean±SD follow-up period for those 28 patients discharged from hospital was 16.6±7.9 months; none of them developed relapse of PVT. The overall mortality and morbidity was 28% and 32%, respectively. There was no relapse of PVT in the other patients.

CONCLUSION

The presence of PVT at the time of OLT is not a contraindication for the operation but those with PVT have a more difficult surgery, develop more postoperative complications, and experience a higher in-hospital mortality.

Experience of living donor liver transplantation in Iran: a single-center report

BACKGROUND

Living donor liver transplantation (LDLT) has been accepted as a valuable treatment for patients with end-stage liver disease seeking to overcome the shortage of organs and the waiting list mortality. The aim of this study was to report our experience with LDLT.

METHODS

We retrospectively analyzed 50 LDLTs performed in our organ transplant center from January 1997 to March 2008. We reviewed the demographic data, family history, operative and hospital stay durations as well as postoperation complications among donors and recipients. We also performed a retrospective analysis of recipient chemical and biochemical data.

RESULTS

Among 50 patients (30 males and 20 females) of overall mean age of 7.21 +/- 5.35 who underwent LDLT (10 right lobe, 38 left lobe, and 2 left lateral segments), 47 received a liver graft from their parent, two from a brother, and one from an uncle. The most common indications for LDLT were end-stage liver disease due to Wilson's disease (16%), cryptogenic cirrhosis (16%), tyrosinemia (14%), biliary atresia (12%), autoimmune hepatitis (12%), and progressive familial intrahepatic cholestasis (12%). The mean follow-up was 16.91 +/- 23.74 months. There were 13 (26%) recipient mortalities including vascular complications; three to sepsis after bowel perforation, two from liver dysfunction, two from chronic rejection due to noncompliance, and one from diffuse aspergillosis. The morbidity rate was 50%, including 19 reexplorations during the hospital course and five biliary complications.

CONCLUSION

This study demonstrated that LDLT can decrease the number of patients awaiting liver transplantation especially in the pediatric group. However, because of relatively high mortality and morbidity, we must improve our treatment outcomes.

The Effectiveness of Little Bird Programme on Improvement of Mental Health and Decrease Parental Stress in Mothers of Autistic Children

This study was a trail of an intervention named Little Bird aimed to decrease parental stress and improve mental health in mothers of autistic children. The sample was 24 mothers of autistic children. The intervention compared across two groups, an intervention group and non-intervention control group. The result indicate that, compared with the control group, mothers in intervention group reported significant improvement in mental health and significant decrease in parental stress following the intervention, at the end of programme and 1 month follow-up.

Nitrous oxide dimer: Observation of a new polar isomer

Spectra of the nitrous oxide dimer (N2O)2 are studied in the region of the N2O nu1 fundamental band around 2230 cm-1 using a rapid-scan tunable diode laser spectrometer to probe a pulsed supersonic jet expansion. The previously known band of the centrosymmetric nonpolar dimer is analyzed in improved detail, and a new band is observed and assigned to a polar isomer of (N2O)2. This polar form of the dimer has a slipped parallel structure, rather similar to the slipped antiparallel structure of the nonpolar form but with a slightly larger intermolecular distance. The accurate rotational parameters determined here should enable a microwave observation of the polar N2O dimer. The need for a modern ab initio investigation of the N2O-N2O intermolecular potential energy surface is emphasized.

Observation of the “missing” polar OCS dimer

A new infrared band at 2069.3 cm-1 is observed and assigned to the long-anticipated polar isomer of the OCS dimer, helping to explain apparent discrepancies among earlier studies. The data reported here should enable direct observation of the microwave spectrum of polar (OCS)2 and motivate new theoretical works on the energetics of OCS dimer isomers and interconversion energy barriers.

Isolation and identification of atrazine-degrading bacteria from corn field soil in Fars province of Iran

In this study several agricultural fields with a long history of atrazine application in Fars province of Iran have been explored for their potential of atrazine biodegradation. After several subculturing for a period of 300 days acclimation, leads to an enhancement of atrazine biodegradation rate. A successful enrichment culture with a high capability for atrazine degradation was obtained (88%). A combination of enrichment culture technique, in a basal salt medium containing atrazine and carbon sources under nitrogen limitation and plating on indicator atrazine agar, have permitted the isolation of bacterial consortium with high capability of using atrazine as a nitrogen source. Seven gram-negative and one gram-positive bacterial strain, which were able to use this herbicide as a sole source of nitrogen, were isolated from Darehasalouie Kavar corn field soil. Based on physiological, biochemical and nutritional characteristics, the isolated bacteria were identified as Pseudomonas alcaligenes, Acidovorax sp., Pseudomonas putida, Ralstonia eutrophus, Pseudomonas syiringe, Erwinia tracheiphila, Entrobacter agglomerans and Micrococcus varians. Therefore, the bacterial consortium in liquid culture containing carbon sources and atrazine as a sole source of nitrogen, degrade added atrazine more than 80%.