JOURNAL OF RESEARCH IN MEDICAL SCIENCES (JRMS)
Year:2017 | Volume:22 | Issue:1|Papers Count:10

Sir, Despite the target to eliminate trachoma as a publichealth concern by 2020, and implementation of approvedstrategies, more than 200 million individuals are livingin endemic regions distributed across 42 nations and areat the risk of developing disease‑induced irreversibleblindness.

Background: Historically, operating room (OR) has always been considered as a stand‑alone trusted platform for surgical educationand training.However, concerns about financial constraints, quality control, and patient safety have urged the surgical educators todevelop more cost‑effective, surgical educational platforms that can be employed outside the OR. Furthermore, trained surgeonsneed to regularly update their surgical skills to keep abreast with the emerging surgical technologies. This research aimed to explorethe value of currently available modern surgical tools that can be used outside the OR and also elaborates the existing laparoscopicsurgical training programs in world‑class centers across the globe with a view to formulate a blended and unified structured surgicaltraining program. Materials and Methods: Several data sources were searched using MeSH terms “Laparoscopic surgery” and“Surgical training” and “Surgical curriculum” and “fundamentals of endoscopic surgery” and “fundamentals of laparoscopic surgery”and “Telementoring” and “Box trainer.” The eligibility criteria used in data extraction searched for original and review articles and byexcluding the editorial articles, short communications, conference proceedings, personal view, and commentaries. Data synthesisand data analysis were done by reviewing the initially retrieved 211 articles. Irrelevant and duplicate and redundant articles wereexcluded from the study.Results: Finally, 12 articles were selected for this systematic review. Data results showed that a myriad ofcutting‑edge technical innovations have provided modern surgical training tools such as the simulation‑based mechanical and virtualreality simulators, animal and cadaveric labs, telementoring, telerobotic‑assisted surgery, and video games. Surgical simulators allowthe trainees to acquire surgical skills in a tension‑free environment without supervision or time constraints.Conclusion: The existingworld‑renowned surgical training centers employ various clusters of training tools that essentially endeavor to embed the acquisitionof knowledge and technical skills. However, a unified training curriculum that may be accepted worldwide is currently not available.

The prognosis of the neoplastic diseases depends not only on the biogenetic characteristics of cancer cells but also on the immunologicalresponse of patients, which may influence the biological features of cancer cells themselves as well as the angiogenic processes.Moreover, the immune system in vivo is under a physiological psychoneuroendocrine (PNE) regulation, mainly mediated by the brainopioid system and the pineal gland. In more detail, the anticancer immunity is stimulated by the pineal hormone melatonin (MLT)and inhibited by the opioid system, namely, through a mu‑opioid receptor. Several alterations involving the pineal endocrine functionand the opioid system have been described in cancer patients, which could play a role in tumor progression itself. Therefore, thepharmacological correction of cancer progression‑related anomalies could contribute to control cancer diffusion, namely, the pinealendocrine deficiency and the hyperactivity of brain opioid system. In fact, the administration of pharmacological doses of the onlyMLT has already been proven to prolong the 1‑year survival in untreatable metastatic cancer patients. Better results may be achievedby associating other pineal indoles to MLT, mu‑opioid antagonists, cannabinoids, beta‑carbolines. Moreover, these neuroendocrinecombinations may be successfully associated with antitumor cytokines, such as interleukin (IL) ‑2 and IL‑12, as a PNE‑immune cancertherapy as well as with antitumor plants as PNE‑phytotherapy of cancer in an attempt to propose possible anticancer treatments alsoto patients with disseminated cancer and untreatable according to the standard oncology.

Background: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a novel surgical technique liverresection in traditionally nonresectable primary intrahepatic tumors or colorectal liver metastases. Materials and Methods: FromJune 2013 to March 2014, patients with primary tumor of liver or colorectal tumors with liver metastasis were selected to evaluatewhether they met the initial criteria for ALPPS procedure.Results: Nine patients enrolled in the study with primary diagnoses of colonand rectosigmoid cancer, carcinoid tumor, gastrointestinal stromal tumor of small intestine, hepatocellular carcinoma, and pancreaticneuroendocrine tumor (PNET). Four candidates excluded from the study prior or during the first step operation due to fatty liver, hepatic fibrosis, peritoneal seeding, and multiple small intestine metastases. Five patients underwent two stages of ALPPS with theinterval of about 1 week. Liver hypertrophy was 100% among our candidates after the initial step. One postoperative death happenedbecause of massive pulmonary thromboembolism Recurrence of liver metastasis was seen in one patient. Hepatic failure Class Band A were observed in two patients which did not progress during follow‑up period. One patient developed an enterocutaneousfistula. Discussion: We recommend to use 2 organ bags, one for wrapping right lobe and the other one for covering visceral organsand also do liver biopsy in suspicious cases of damaged liver parenchyma and laparoscopic exploration of abdomen for seeding andmultiple metastases prior to laparotomy.Conclusion: As the procedure has not been well established and verified by oncologistsyet, further studies are required to define the exact indications of ALPPS.

The hyperimmunoglobulin E syndromes (HIESs) are very rare immunodeficiency syndromes with multisystem involvement, including immune system, skeleton, connective tissue, and dentition. HIES are characterized by the classic triad of high serum levelsof immunoglobulin E (IgE), recurrent staphylococcal cold skin abscess, and recurrent pneumonia with pneumatocele formation.Most cases of HIES are sporadic although can be inherited as autosomal dominant and autosomal recessive traits. A fundamentalimmunologic defect in HIES is not clearly elucidated but abnormal neutrophil chemotaxis due to decreased production or secretionof interferon γ has main role in the immunopathogenesis of syndrome, also distorted Th1/Th2 cytokine profile toward a Th2 biascontributes to the impaired cellular immunity and a specific pattern of infection susceptibility as well as atopic‑allergic constitutionof syndrome. The ophthalmic manifestations of this disorder include conjunctivitis, keratitis, spontaneous corneal perforation, recurrent giant chalazia, extensive xanthelasma, tumors of the eyelid, strabismus, and bilateral keratoconus. The diagnosis of HIESis inconclusive, dependent on the evolution of a constellation of complex multisystemic symptoms and signs which develop overthe years. Until time, no treatment modality is curative for basic defect in HIES, in terms of cytokines/chemokines derangement. Ofnote, bone marrow transplant and a monoclonal anti‑IgE (omalizumab) are hoped to be successful treatment in future.

Background: The aim of this study is evaluation of the validity and reliability of the Persian version of Knee Injury and OsteoarthritisOutcome Score (KOOS) in patients with isolated meniscus injury. Materials and Methods: One hundred people with isolatedmeniscal injury (29 females and 71 males with a mean age ± standard deviation [SD] =32.37 ± 9.97 years) and fifty normal peoplewith no knee problems (34 females and 16 males with a mean age ± SD=28.42 ± 8.84 years) participated in this study. In patients, the duration of meniscus injury ranged from 1 month to 4 years. For evaluation of discriminate validity, we compared scores ofKOOS questionnaire between patients and healthy people, and for concurrent validity, in addition to filling KOOS questionnaire, patients completed Short Form (SF‑36) questionnaire, test–retest reliability with intraclass correlation coefficient) ICC), and internalconsistency with Cronbach’s alpha was calculated.Results: Mean scores of patients (49.51 ± 17.13) and healthy people (86.01 ± 13.44)were different significantly (P<0.001). The correlation between total score of SF‑36 and KOOS was significant (r=0.77, P<0.001).ICC was 0.80 (ranged from 0.64–0.75) and Cronbach’s alpha was 0.96 (ranged from 0.72 to 0.94).Conclusion: The Iranian versionof KOOS is a reliable and valid tool for patients with isolated meniscus injury, so the clinicians and investigators may use thisquestionnaire in clinical settings and their researches.

Background: The Wilms tumor 1 (WT1) gene is originally defined as a tumor suppressor gene and a transcription factor thatoverexpressed in leukemic cells. It is highly expressed in more than 80% of acute myeloid leukemia (AML) patients, both in bonemarrow (BM) and in peripheral blood (PB), and it is used as a powerful and independent marker of minimal residual disease (MRD); we have determined the expression levels of the WT1 by real‑time quantitative polymerase chain reaction (RQ‑PCR) in PB and BMin 126 newly diagnosed AML patients. Materials and Methods: This study was done in molecular pathology and cancer researchcenter from April 2014 to June 2015, RQ‑PCR method was used to determine the WT1 gene expression in BM and/or PB samplesfrom 126 patients of AML, we cloned both WT1 and ABL genes for creating a standard curve, and we calculate copy number ofWT1 genes in patients.Results: A total of 126 AML patients consist of 70 males (55.6%) and 56 females (44.4%), with a median ageof 26 years; 104 (81%) patients out of 126 show overexpression of WT1 gene. We also concomitant monitoring of fusion transcripts(PML RARa, AML1‑ETO, MLL‑MLL, CBFb‑MYH11, or DEK‑CAN) in our patients, the AML1‑ETO group showing remarkablylow levels of WT1 compared with other fusion transcript and the CBFB‑MYH11 showing high levels of WT1.Conclusion: Weconclude that WT1 expression by RQ‑PCR in AML patients may be employed as an independent tool to detect MRD in the majorityof normal karyotype AML patients.

Background: Posttraumatic and/or postsurgical knee stiffness is one of the orthopedic complications which is difficult to be treatedand can affect individual’s life negatively. The aim of this study is to investigate the results of quadricepsplasty in patients with kneestiffness resulted from femoral fracture. Materials and Methods: This is a cross‑sectional study on all patients with femoral fracturewhich has caused knee flexion limitation referred to Kashani and Al‑Zahra Hospitals in Isfahan from January 2010 to March 2013. Thetype and site of fracture, joint extension, and fracture fixation technique were recorded. Moreover, the range of motion (ROM) beforesurgery, under general anesthesia, and 3‑ and 6‑month postoperation were measured.Results: Among the patients, 13 had a simplefracture (48%) and 14 had a segmental fracture (51.9%). Considering the fracture site, 11, 10, and 6 patients had femoral (40.74%), supracondylar (37.3%), and femoral supracondylar (22.2%) fractures, respectively. The fracture fixation was performed by theplate, external, and Wagner fixation techniques for 24 (88.9%), 2 (7.4%), and 1 (3.7%) patients, respectively. The mean ROM beforeoperation, under general anesthesia, and 3‑ and 6‑month postoperation were determined to be 33.15 o ± 24.73 o, 122.60 o ± 10.22o, 99.63 o ± 16.52 o, and 100.74 o ± 15.67 o, respectively. The mean ROM value at various stages was not similar (P<0.001). The meanchanges in the ROM were 79.2 o ± 24.6 o and 62.1 o ± 19.7 o in the cases with simple and segmental fractures, respectively. The meanchanges in the knee ROM were significantly higher in simple fractures in comparison with the segmental femoral fracture (P=0.03).Conclusion: We found Thompson’s quadricepsplasty may successfully increase the range of knee flexion in knee fracture and alsoregardless of quadriceps time.

Background: This study was conducted to assess the validity and reliability of ankle‑brachial index (ABI) by oscillometric bloodpressure (BP) measurement as compared with an automated ABI as a gold standard. Materials and Methods: This study was conductedat Golden Jubilee Medical Center, Thailand. All the data were collected from 303 patients at risk of peripheral arterial disease (PAD)who were 45 years of age or above and who underwent treatment at the outpatient medical clinic between June and December 2015.Patients who were followed up at the medical clinic had both oscillometric BP measurement (Terumo, ES‑P600) and an automatedABI (oscillometric method) at the same time. Sensitivity, specificity, positive predictive value, and negative predictive value of theoscillometric BP measurements to predict an abnormal ABI (<0.90) were determined using the automated ABI as the gold standard.Results: ABI values were similar between the two methods. The oscillometric BP method for determining an ABI (cutoff point<0.90)on the right side had a sensitivity of 88.89%, specificity of 99.32%, an accuracy of 99.01%, a positive predictive value of 80%, and anegative predictive value of 99.32% whereas ABI on the left side had a sensitivity of 69.23%, a specificity of 99.66%, an accuracy of98.35%, a positive predictive value of 90%, and a negative predictive value of 98.63%. Reliability of the oscillometric BP method byKappa statistics was 0.84 on the right side and 0.77 on the left side (P=0.000).Conclusion: The oscillometric BP method is a reliableand useful alternative to conventional automated ABI determination in patients with no severe arterial occlusion for estimation ofthe prevalence and screening of PAD in primary health‑care settings.

Background: Considering the existence of controversies about the predictive value of inflammatory markers for cardiovasculardisease (CVD), we aimed to compare the level of high‑sensitivity C‑reactive protein (hs‑CRP) and interlukin‑6 (IL‑6) level in chronichemodialysis (HD) patients with and without CVD. Materials and Methods: In this historical cohort study, HD patients with andwithout CVD disease were enrolled. The presence of CVD risk factors, level of inflammatory factors including IL‑6 and hs‑CRP aswell as lipid levels, fasting blood sugar, and other biochemical factors were compared in two studied groups.Results: During thestudy, eighty HD patients with (n=40) and without (n=40) CVD were enrolled. Diabetes was more prevalent among HD patientswith CVD than those without CVD (P<0.05). The level of IL‑6 and hs‑CRP were not different in two studied groups (P>0.05).Univariate analysis of variance test indicated that there was not any significant relationship between hs‑CRP and CVD (P>0.05).Conclusion: The findings indicated that the level of inflammatory factors including hs‑CRP and IL‑6 are not significantly differentin HD patients with and without CVD. However, for obtaining more definite conclusion in this field and evaluation their predictingrole in this field, it is recommended to study other novel inflammatory markers as well as the additive effect of the inflammatoryfactors with traditional ones in larger sample size and longer follow‑up.