Tehran University Medical Journal
Year:2017 | Volume:75 | Issue:2|Papers Count:14

Blood transfusion is commonly implemented to manage life and health-threatening conditions on a rapid and short-term basis. Over the years, ongoing technical advances have dramatically improved transfusion medicine to provide more safety and effectiveness. However, transfusion is still complicated with different adverse events that mainly induced by the presence of allogeneic leukocytes in the blood products.Several lines of evidence have shown that leukocytes in blood components are involved in the induction of febrile nonhemolytic transfusion reactions (FNHTRs), HLA alloimmunization and platelet refractoriness as well as the increased risk of the infectious diseases transmitted by leukotropic viruses including cytomegalovirus (CMV), human T-lymphotropic virus (HTLV) -I/II and Epstein-Barr virus (EBV).During current decades, introducing various leuko-reduction techniques have shown to be associated with less transfusion related adverse events and improved clinical outcomes. The lower incidence and severity of febrile transfusion reactions; reduced risk of transfusion related transmission of CMV or other leukocyteassociated infections, lowered incidence of alloimmune platelet refractoriness in addition to reducing risk of mortality and morbidity in patients are considered as clinical benefits of leuko-reduced products. Currently, by the use of 3rd and 4th generation of filters, the highest levels of leukoreduction in blood components have been achieved. Filtration techniques have also the advantages of being performed shortly after preparation of components (pre-storage) or post-storage even at the patient’s bedside. However, it seems that pre-storage depletion of leukocytes provides better protection than post-storage techniques due to the elimination of leukocytederived cytokines effects which are increasingly released during storage. Particularly in platelet products, the earlier depletion of leukocyte also favors less platelet-induced leukocyte activation which may be triggered by the interaction between either activated platelets or their released chemokines and residual leukocytes during storage. Despite the benefits attributed to leukoreduction of blood components, the global use of leukoreduced products is commonly hampered by its high cost especially in developing countries in which leukoreduction of blood components is usually limited to some patients with special conditions. In this review, after briefly introducing of some transfusion adverse events that are attributed to allogeneic leukocytes existed in blood products, the effects of leukoreduction process in the attenuation of these events will be discussed.

Background: Electrolysis is an electrochemical method for the treatment of water.Recently water disinfection by electrochemical methods has been increasingly carried out. The aim of this applied research was to investigate the removal ofEscherichia coli (E. coli) and Staphylococcus aureus (S. aureus) bacteria from drinking water by using electrolysis method with Al-Fe electrodes parallel with the monopole mode.Methods: An experimental study was conducted in the laboratory of microbiology, Iran University of Medical Science in May 2017. In this study, the contaminated water samples were prepared through adding 103, 104 and 105 E. coli and S. aureus bacteria per 1 milliliters (mL) of drinking water. Independent variables Included: different concentrations ofE.coli and S. aureus bacteria (103, 104 and 105 CFU/ml), reaction time (5, 10, 15, 20 and 25 min), initial pH (7, 8 and 9), electrode gap (1, 2 and 3 cm), current density (0.83, 1.67 and 3.3 mA/cm2) to determine the optimum conditions were investigated. One-way ANOVA was used to analyze the results.Results: The results show that in the optimum conditions with increasing the pH from 7 to 9 removal efficiency of bacterial strains ofE. coli and S. aureus were decreased significantly from 98 to 73% and 99.1 to 76%, respectively. In initial concentration of 104 CFU/ml, optimum conditions were obtained for current density, reaction time and electrodes gap, 1.67 mA/cm2, 20 min and 2 cm, respectively. With increasing current density and reaction time in both strains of bacteria, were decreased significantly. The electrodes gap do not have much impact on the efficiency of the process. The amount of electrical energy consumed in optimal conditions was calculated 0.5128 kilowatt-hour (kWh/h). Statistical analysis shows that exist significant relationship (P<0.01) between initial concentrations of bacterial strains and efficiency of the process.Conclusion: According to the results, E. coli and S. aureus, removal efficiency were obtained more than 98%, therefore electrolysis process can be used in the removal of pathogenic bacteria from drinking water.

Background: Postoperative pain is one of the most common complications following laparoscopic cholecystectomy. Because the majority of the analgesic drugs including opioids and nonsteroidal anti-inflammatory drugs have many side effects, using drugs with lesser side effects is beneficial. The aim of this study was to evaluate the effect of N-acetylcysteine on the pain after laparoscopic cholecystectomy.Methods: In a randomized clinical trial, in two university-affiliated teaching hospitals in Babol City (Shahid Beheshti and Shahid Yahyanezhad Hospitals), Iran, from August 2015 to March 2015, a total number of 38 patients with age of 20-50 years, who were candidates for laparoscopic cholecystectomy with American Society of Anesthesiologists Class-I were chosen and randomly assigned into two groups. The night before operation, 1200 mg oral N-acetylcysteine is given to intervention group.Also, they received 600 mg IV N-acetylcysteine in the morning before operation. In the control group, two vitamin C effervescent tablets as placebo were given at night before operation and 3 ml sterile water as placebo was injected in the morning of operation.Amount of pethidine consumption and the changes in hemodynamic in two groups was recorded and analyzed at 24 hours after operation.Results: The average of patients age was not significant different between two groups (P=0.23). Average of pain score in placebo group was 3.5 and in N-acetylcysteine group was 2.7 that it was not significant difference between two groups (P=0.06).Average of pethidine consumption in placebo group was 52 mg and in N-acetylcysteine group was 29 mg in 24 hours, that the difference was statistically significant between two groups (P=0.01).Conclusion: As the results of the study, it can be concluded that the anti-inflammatory effects N- acetylcysteine can inhibit the function of lipoproteins and prostaglandins, reduced glutathione peroxidase and dismutase has been restored and can be used to treat pain or analgesic dose reduction. In this study the N-acetyl cysteine has reduced pain after laparoscopy and analgesic dose of mepridine.

Background: Due to the presence of radiosensitive organs in the abdominopelvic region and increasing the number of requests for CT scan examinations, concerns about increasing radiation doses in patients has been greatly elevated. Therefore, the goal of this study was to determine the absorbed dose of radiosensitive organs and the effective dose in patients underwent abdominopelvic CT scan using ImPACT CT patient dosimetry Calculator (version 1.0.4, Imaging Performance Assessment on Computed Tomography, www.impactscan.org).Methods: This prospective cross-sectional study was conducted in Imam Reza Hospital from November to February 2015 February 2015 in the Imam Reza Hospital, in Urmia, Iran. The demographic and dosimetric information of 100 patients who underwent abdominopelvic CT scan in a 6-slice CT scanner were obtained through the data collection forms. The demographic data of the patients included age, weight, gender, and BMI. The dosimetric parameters included pitch value, CT dose volume index (CTDIvol), dose-length product (DLP), tube voltage, tube current, exposure time, collimation size, scan length, and scan time. To determine the absorbed dose of radiosensitive organs and also the effective dose in patients, ImPACT CT patient dosimetry calculator was used.Results: The results of this study demonstrated that the mean and standard deviation (SD) of patients' effective dose in abdominopelvic CT scan was 4.927±0.164 mSv. The bladder in both genders had the greatest mean organ dose, which was 64.71±17.15 mGy for men and 77.56±18.48 mGy for women (P<0.001).Conclusion: The effective dose values of this examination are in the same range as previous studies, as well as International Commission on Radiological Protection (ICRP) recommendations. However, the radiation dose from CT scan has the largest contribution to the medical imaging. According to the ALARA principle, it is recommended that the scan parameters, especially mAs, should be chosen so that the patient dose is minimum, and the image quality is maximum. Furthermore, other imaging modalities are used as an alternative to the CT scan.

Background: Anode heel effect refers to reduction of radiation intensity in the anode side of X-ray tube. This variation in radiation intensity across the anode-cathode of Xray tube can be benefited for decrease radiation exposure in some radiological examinations. The aim of this study was to evaluate the effect of anode heel orientation on the radiation dose received by the testes in male patients undergoing pelvic radiography.Methods: This is a cross-sectional study, conducted at one of the teaching hospitals of Ahvaz, Jundishapur University of Medical Science Ahvaz, Iran, from September 2015 to March 2016. In order to measure the profile of radiation intensity variation, 13 paired sets of high radiosensitive cylindrical lithium fluoride thermo-luminescent dosimeters (TLD) aligned on the cathode-anode central axis upon the table and then irradiated using routine exposure parameters. The anode of X-ray tube was positioned toward the feet for 40 patients and toward the head for 39 patients undergoing pelvic radiography.For measure the entrance skin dose (ESD), 8 TLD chips were located on the central point of the radiation field and 5 TLDs were located on the testes position to measure the dose received.Results: Radiation intensity profile showed that radiation intensity decrease from the cathode to the anode side. Discrepancy of radiation intensity on central axis of cathodeanode was calculated about 35%. The radiation dose received by the testes was 26.74% lower for patients the anode directed toward the feet, compared to the patients in which the anode directed toward the head (FTC: 1.260±0.296 mGy, FTA: 0.923±0.167 mGy, P<0.05). There was no meaningful difference for the measured ESD of pelvis between two groups of patients (FTC: 1.256±0.315 mGy, FTA: 1.195±0.205 mGy, P=0.788).Conclusion: In pelvic radiography, positioning of testes directed to the anode of X-ray tube can decrease the receive dose.

Background: Application of Hybrid 6 degrees of freedom fixation could lead to space motion in each 3 anatomic plates together and decrease the time of complex deformities correction. This study is an investigation on the function of hybrid external fixation and the influence of it on decreasing the treatment time. About this case utilize of Ortho-SUV Frame (OSF) system is explained for the first time in Iran and report of its novel.These robotic systems are divided into two groups: active and passive, about active system all movements are done by actuators in joints and links. And in passive, the system needs an operator or patient to actuates Sturats by hand.Methods: The femur bone has been investigated was nonunion with deformity in sagittal, frontal and transversal planes. Ilizarov external fixation was applicate firstly, with this condition that the OSF systems jacks were replaced instead of simple rods in side of fracture. Software work was done on February of 2016 in Ayatollah Taleghani Hospital, Tehran, Iran. Fractures were happened in a car accident and some other operating were perforemed for this patient without any result.Results: The correction of studied deformity needs 3 planar moving. Acting this movement by Ilizarov requirements 33 mm displacement in frontal plane, 12 mm horizontal distraction and 48 mm displacement in sagittal plane. Due to the rate of correction in Ilizarov which is 1 mm per day, this bone needs 93 days for general correction and three times changing in shape of rings connections. While, by using the hybrid external fixation, all displacements were corrected in 46 days and first connection had supported all planes.Conclusion: According to that the decreasing of treatment time is one of the main goal, the hybrid external fixation systems could be an appointment choice in complex deformities and replaced with some common fixation. In addition to, using of updated software increases the accuracy of displacement.

Background: Low back pain is one of the most important causes of disability among people around the world. Although only 2-5% of low back pain disorders resulting from herniation of lumbar intervertebral discs but surgery for lumbar disc herniation is a common procedure. The aim of this study was to determine the relation between some bio-psycho-social variables and treatment outcomes in patients who undergo first time single-level lumbar discectomy.Methods: This is a prospective observational analytic study comprised 100 patients (age range 18-73 years) underwent single-level lumbar disc surgery. The patients who met our inclusion criteria and were willing to participate in the study were recruited from the neurosurgery ward of Logman and Imam Khomaini hospitals in Tehran, Iran, between October 2015 and March 2016. The patient completed SF-36 quality of life Questionnaires before, one and two months after surgery.Results: In comparison to standard values, before the surgery patients had significantly lower baseline SF-36 (36-Item Short Form Survey) Questionnaire value in all 8 domains. The role limitations due to physical health had greatest impact on quality of life. At the eight weeks’ follow-up SF-36 scores showed significant improvement in both physical and mental scales. Age had no significant impact on mental scales of weeks’ Questionnaire but in age less than 30 years there was a positive relation between the patient’s age at surgery and physical aspects of quality of life. Although there was no significant difference in physical aspects of SF-36 Questionnaire between males and females but males had a significantly higher mean mental health score than females after surgery. Smokers had lower value of mental scales of SF-36 Questionnaire than in nonsmokers.Conclusion: The result of this study showed that surgery for lumbar disc herniation had a great impact on both physical and mental scales of SF-36 Questionnaire two months after surgery. Factors such as age, sex, smoking and psychological factors can play the role of predictor for patient’s outcomes after lumbar disc surgery.

Background: The Micronuclei has been discussed as an indicator of chromosomal damage in radiotherapy. This study aimed to investigate the changes of micronuclei in peripheral blood lymphocytes of patients with of the gastrointestinal cancers pre- and post-chemo-radiation.Methods: This cross-sectional study was conducted in patients with gastrointestinal cancers who referred to oncology ward of Rasool Akram Hospital in Tehran from January to March, 2016. After obtaining informed consent from all patients, 3 cc of peripheral blood samples was obtained for cytogenetic assessment in two stages, before treatment and 4 weeks after treatment. The frequency of micronuclei was examined per 1, 000 lymphocytes with two nuclei.Results: Sixty-one patients were evaluated and 11 patients were excluded at the end of study. Fifty patients (34 males, 16 females) with a 59.74±13.34 years old were evaluated.24 (48%) and 26 patients (52%) were in the less than 60 years’ age group and more than one, respectively.37 cases (74%) with gastric cancer and 13 cases (26%) with esophageal cancer enrolled in the study. The significant differences were meaningful pre- and post-treatment (44.88 vs.364.4 /1000 cells) (P=0.005). Also, there were no significant differences of the mean number of micronuclei between pre- and post-treatment according the type of cancer, sex and age groups. Further analysis according by age, sex and cancer of the esophagus or stomach showed no statistically significant differences between the groups in micronuclei number. In other words, chemotherapy and radiation in patients, regardless of age, sex and type of gastrointestinal cancer is very significant impact on the micronuclei production in peripheral blood of patients.Conclusion: The number of micronuclei in peripheral blood increased significantly in patients with gastrointestinal tract cancer (esophagus and stomach) under the chemoradiation therapy. It seems that this increase was not correlated with age, sex and type of cancer (stomach or esophagus).

Background: Hyperbilirubinemia is the most common cause for readmission in the early neonatal period 5 to 36 percent of healthy term infants who are discharged from hospital are again hospitalized due to severe to moderate hyperbilirubinemia.Detection of major and minor risk factors associated with neonatal jaundice helps to identify high-risk infants and prevent neonatal jaundice. This study was performed aiming to evaluate the major and minor risk factors associated with jaundice in infants hospitalized.Methods: This cross-sectional study was performed on 2207 term infants (<15 days) with hyperbilirubinemia (>15 mg/dl) in neonatal clinic or emergency unit or neonatal intensive unit, of Mashhad Ghaem Hospital, Iran, from April 2010 to May 2016. The jaundice of infants was confirmed by the pediatrician and laboratory tests. Then the researcher-made questionnaire containing maternal information and neonatal characteristics was completed. Values were expressed as mean±SD. Student t-test and Mann-Whitney test were used as appropriate. P-value less than 0.05 was considered significant.Results: Sixty one percent of neonates had major risk factors and 80% of neonates had minor risk factor for jaundice. For neonatal jaundice, the most common major risk factors were significant weight loss (27.5%), jaundice visible in the first 24 hours (16.3%), history of treatment with phototherapy and exchange transfusion in sibling (14.8%), Gestational age of 35 to 36 week (9.9%), ABO incompatibility (9.2%), RH incompatibility (3.3%) and G6PD deficiency (3.33%), and the most common minor risk factors were age over 25 years (51.4%), male (49.7%), history of hyperbilirubinemia in sibling (22.3%), diabetic mother's infants (1.5%).Conclusion: The major risk factors for neonatal hyperbilirubinemia were significant weight loss, jaundice visible in the first 24 hours, history of treatment with phototherapy and exchange transfusion in sibling, gestational age of 35 to 36 week, ABO incompatibility, RH incompatibility and G6PD deficiency.

Background: Osteoblastoma is one of the rarest primary benign bone tumors which accounts for 1% of all bone neoplasms and 3.5% of benign bone tumors, with the potential for local invasion and recurrence. Osteoblastoma is not homogeneous.Differences in histological details have led to the division of these lesions into subtypes.The histologic features in most cases are distinctive, there are various changes that make the diagnosis challenging. Although involvement of this disease is more in the spines or small long bones, but it has been reported involvement of jaws in this disease.Correct diagnosis is very important because it may be misdiagnosed osteosarcoma with hypercellular cases.Case presentation: In this case report, it is described patient a 7-year-old girl with a lesion in the posterior maxilla and bone resorption in May 2016, Sari, Mazandaran province, Iran. Differential diagnosis of the radiological and clinical findings suggested an osteosarcoma. In terms of pathology, osteoblastoma was included a wellvascularized connective stroma tissue with plenty of veins which osteoid and primitive woven bone can be seen actively. In microscopy diagnosis, samples were shown cortical bone with a natural appearance, prominent osteoblasts and surrounding granulation tissue containing blood vessels that confirmed maxilla osteoblastoma. The lesion was examined by histopathology method for final recognition and the results revealed osteoblastoma.Conclusion: Although jaw osteoblastoma is a rare tumor and presents with microscopic features that can mimic a variety of other types of malignant entities. It is important to avoid of other non-specific clinical and radiographic protests that led to the recognition problems. The importance of interdisciplinary cooperation between the surgeon, radiologist and pathologist must be pressured.