TEHRAN UNIVERSITY MEDICAL JOURNAL (TUMJ)
Year:2018 | Volume:76 | Issue:4 |Papers Count:13

Today, nanoscience has grown and developed in various medical and therapeuticareas, including cancer treatment. On the other hand, cancer and its types have beenrumored and inclusive and many people suffer from this fatal and deadly disease. Currently, existing therapeutic method, including chemotherapy, radiotherapy, andetc., along with the therapeutic effect, cause complications that are unpleasant forpatients. Hence, scientists and researchers are looking to develop and improvetreatment options and methods to deal with this serious disease. Today, nanoscienceand nanotechnology have become widespread, and its various fields, includingnanoparticles, are widely used for a variety of applications, especially for delivery ofdrugs and diagnostic items and imaging cases. Nanotechnology-based releasesystems have a significant impact on the release of cancer drugs. Advances in biomaterialsand bio-engineering are contributing to new approaches to nanoparticlesthat may create a new way for the improvement of cancer patients. Nano-technologyin the drug release system has had a great impact on the selection of cancer cells, therelease of a targeted drug, and overcoming the limitations of conventionalchemotherapy. At the present many drug delivery systems are now made ofnanoparticles, and various substances have been used as drug-stimulating agents oras a reinforcing agent to improve the efficacy of the treatment and durability andstability and also the safety of anticancer drugs. The materials used to release cancerdrugs are divided into various categories such as polymer, magnetic, biomolecules. In the meantime, polymer nanoparticles have been organized in the carriers of anticancernanoparticles due to the process of easy production, biocompatibility, andbiodegradability. Although the loading of hydrophilic compounds is still confrontedwith limitations, due to the diversity of nanoparticle structures, it is possible toencapsulate various molecules. Also, surface changes and modification such asbinding to antibodies and target ligands can also be applied to these materials, to actas target drug delivery to increase the effectiveness of treatment process. In thisarticle, we will have an overview of cancer disease and cancer drugs and alsonanoparticles and their contribution to cancer treatment.

Cancer is one of the most dangerous health problems of today modern societieswhich has an increasing rate especially in developing countries. There are manydiverse ongoing treatment attempts trying to defeat cancer. Despite that, scientistshave been unable to find a permanent cure for this disease. In many cases althoughthere is a successful first response in patients, cancer cells are finally able towithstand therapeutic procedures and even use chemo-resistance to take advantageof treatments to facilitate tumor growth, resulting in cancer remission. Therefore, andmostly in recent two decades, scientists have been trying to choose their treatmentsjust as smart to be able to conquer cancer. One of the best methods of this smartdefense is to target weak points of neoplastic cells and use them for designing drugs. In this case it would be most probable for cancer cells not to have a chance to confrontand cause chemo-resistance. Total endeavors to fulfill this goal are named “ targetedcancer therapy” . This therapeutic approach is mostly consisted of two differentprocedures: 1-designing and using specific drugs to target cancer cells’ mutatedgenes; which will be defined by checking the genetic background of tumor cells foreach specific cancer type. EGFR, RAS, VEGF and HIF-1α are among the pathwaysthat have already been used as targets. 2-The other procedure could be methods thatwould carry drugs directly to unhealthy cells to prevent further side effects for normalcells of patients. It would be possible by designing specific antibodies to targetantigens of neoplastic cells. Ribonucleic sequences (miRNAs and siRNAs) are alsovery promising as new drugs and nanoparticles have enabled us to increase drugconcentration in tumors. The ultimate goal of these new experiments is to suggestspecific drugs for each patient based on the nature of one's disease and geneticbackground, which will bring about "personalized medicine" era. Using valid newreferences, this review article first presents targets that are currently being used forthis targeted therapy, their logic of choice and the drugs that have already beenproduced for clinical trials. Smart methods of drug delivery are also presented anddiscussed afterwards.

Background: Children's health, preserving and promoting it is a health priority of anysociety. Malnutrition affects all age groups, but malnutrition in children is one of themost common nutritional problems that can delay body growth, shortened height, frequent infections, mental retardation, the prevalence of mental disorders, lack ofacademic achievement and reduced efficacy. Because of the importance and impact ofthis issue in children, the purpose of this study was a systematic review and metaanalysisof the prevalence of underweight in Iranian children, in order to highlight theimportance of this issue to health policy-makers. Methods: A meta-analysis was performed for relevant articles in scientific databasesincluding Scientific Information Database (SID), ScienceDirect, PubMed and GoogleScholar. Entrance criteria included cross-sectional studies (March 1996 to February2017) that had a low incidence of underweight in Iranian children in different parts ofIran. Non-relevant articles included review articles, interventions, cohorts and casestudies, and studies that looked at obesity, overweight and the relationship betweenthese factors and other diseases, excluded from the study list. Reference lists ofidentified articles were reviewed for additional articles. Heterogeneity of study waschecked using I2 index and the possibility of publication bias by funnel plot and Beggand Mazumdar's rank correlation test and a significance level of 0. 1. Data wereanalyzed using the comprehensive meta-analysis software, version 3 (Biostat, Englewood, NJ, USA). Results: In 26 articles reviewed in the study, total number of participants was 142938persons at the age of 1 month to 12 years. The overall prevalence of underweight inIranian children was 15. 5% (Cl 95%: 12%-19. 7%) during 1996 to 2017. The highestprevalence of underweight in was recorded in Birjand city in 2006 and Zahedan city in2009, 68. 6% (Cl 95%: 63. 3%-72. 9%) and the lowest prevalence of underweight in wasfound in city of Jahrom in 2013, 1. 8% (Cl 95%: 1. 2%-2. 9%). Conclusion: According to the results of this study, the prevalence of low-birth-weightin the country is high and requires interventional measures.

Background: Labor induction is one of the most public ways carried out global fordelivering mothers. The aim of labor induction is to encourage uterine contractionsbefore the spontaneous onset of labor, resultant in vaginal delivery misoprostol is usedoff-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion, medical management of miscarriage, induction of labor, cervical ripening before surgical procedures, and the treatment of postpartumhemorrhage. Regarding the importance and lack of similar researches in Iran, thisresearch was done to compare the efficacy of buccal and sublingual misoprostol forlabor induction in pregnant women. Methods: This study was conducted as a randomized double-blind clinical trial fromMarch 2017 to February 2018. In this survey, 200 women were randomly assigned toreceive 50 μ g buccal misoprostol and sublingual (100 buccal and 100 sublingual) inKosar Hospital, Qazvin University of Medical Sciences, Iran. The maternal and fetalcomplications, Bishop score, and time of pain onset and its interval with labor weremonitored in two groups and the findings were analyzed. Results: Research variables were age, gestational age, BMI, number of previouspregnancy, neonatal weight, total dose, Bishop score 1, Bishop score 6, oxytocin, anddelivery type. The results showed that there were no differences between Bishop score6 (P=0. 07), and 1 (P=0. 36), total dose (P=0. 58), neonatal weight (P=0. 43), number ofpregnancy (P=0. 67), BMI (P=0. 67), and pregnancy weak (P=0. 108) of sublingual groupand buccal group. About 43 patients (43%) in buccal and 64 (64%) in sublingual grouphad vaginal delivery (P=0. 05). The frequencies of maternal and fetal complicationswere similar between two groups. Conclusion: It can be concluded that there is no difference between efficacy ofsublingual and buccal misoprostol in pregnancy results, maternal, and fetalcomplications, however, it seems that the sublingual group is more effective thanbuccal group due to the significant amount of vaginal delivery, achieving vaginaldelivery in less than 24 hours, and less need for oxytocin.

Background: The role of high levels of parathyroid hormone in the development ofanemia either directly or by mediating mechanisms is unclear, and there is acontroversy about the pathophysiological role of parathyroid hormone (PTH) in thedevelopment and intensification of anemia associated with renal disease. The aim ofthis study was to investigate the relationship between anemia and parathyroid hormoneand dialysis adequacy in chronic hemodialysis patients. Methods: A cross-sectional study was performed in patients undergoing dialysis inSoodeh Hemodialysis Center, Vavan city, Tehran province, Iran, in two years(September 2013 to September 2015). Patients with age>18 years who underwentdialysis for at least three months were enrolled. Anemia was calculated based on theabsolute amount of hemoglobin, hematocrit, and the percentage of patients whoachieved the hemoglobin treatment goal of more than 11 g/dL. Parathyroid hormonelevels were measured intact PTH and enzyme immunoassay (EIA) method. Results: 176 patients who had entry criteria participated in this study. Patients included102 males (58%) and 74 women (42%). The mean age of the patients was 54. 14± 13. 98years (18-85 years). The mean weight of patients was 68. 07± 14. 17 kg (36-120 kg). 23(13. 1%) of the patients had a previous history of kidney transplantation. Of the 176patients, only one had a history of parathyroidectomy (0. 6%). The mean dialysis time inthe patients was 6. 38± 5. 29 years (1-28 years). The type of dialysis access in 132patients (75%) was AV fistula and in 44 patients (25%) was Shaldon catheter. Themean erythropoietin intake of patients was 10, 000 units per week. The mean ofhemoglobin, hematocrit and PTH were 10. 73 g/dl 33. 6% and 403 pg/ml, respectively. Conclusion: The findings of the study showed that there was no significant correlationbetween hemoglobin and hematocrit levels with parathyroid hormone levels anddialysis adequacy. Increased levels of serum iron, total iron binding capacity (TIBC)and resistance to erythropoietin were associated with a decrease in hematocrit levelsdue to decreased hemoglobin levels and resistance to erythropoietin.

Background: The study of their knowledge, attitude, and behavior toward health is anessential step for health planning. In the urban area, there are several concerns aboutenvironmental pollution, health status, the dangers of insecurity, and bad dietary habits. The aim of the study was the determination of knowledge, attitude, and behavior ofTehran citizens in order to plan better municipal services. Methods: This descriptive, cross-sectional study was conducted on 13000 participantsbetween 15-84 years in 22 districts of Tehran, Iran University of Medical Sciences, inAugust and September of 2011. Cluster sampling and self-administered reliable andvalid questionnaire were used for data gathering. The inclusion criteria are all ofcitizens of Tehran. Age, sex, marital and job status, obesity, physical activity, hypertension, myocardial infarction, accidents, diabetes, nutrition, stroke, psychologicalbehavior, smoking, addiction and drugs, musculoskeletal, sexual behavior, anemia, physical environment, fat blood, cancer, chronic obstructive pulmonary disease, dietaryhabits and socioeconomic status were measured under standard protocols and by usingcalibrated instruments. Results: From 13000 participants in the study, 11753 (90%) was fulfilled thequestioners. Nonresponse rate from 11753 participants was 8. 6%. The proportion ofobesity/overweight was 50% and 29. 5% of people had appropriate physical exercise, 37. 6% reported a tobacco consumer in their family and 4. 5% reported an experience ofsubstance misuse. Also, 29. 2% and 24. 8% from these had anomalistic consuming ofsalt and soft drink, respectively. Of the participants, 44. 8%, 89. 1% had a goodknowledge and attitude, respectively. Cronbach alpha coefficient was 0. 82 and 0. 79 forknowledge, attitude and behavior, respectively. In additional, the correlation coefficientbetween test and re-test questions was 0. 91. Conclusion: This study was a comprehensive study to measure the knowledge, attitudeand practice of Tehran citizens using reliable and valid questionnaires about generalhealth status. A considerable percentage of Tehran citizens suffering from overweight, obesity, hypertension, diabetes, high blood lipids and smoking consuming and usinganomalistic from TV and computer. The results can be used as a framework and guideto prioritize problems and planning health education interventions in Tehran.

Background: Burns are one of the most devastating forms of trauma worldwide. In theelderly, flame and scald burns, or scalds alone, are the major causes of burns, occur athome, particularly in the kitchen and bathroom. Because elderly burned patients sufferfrom greater morbidity and mortality than younger patients with similar burn extents, preventing burns is paramount to continuing functionality and quality of life. Burns arelargely explainable by characteristics of both the individual and the physicalenvironment. Our study aims to analyses the epidemiologic characteristics of burn inthe elderly (above 60 years old) in Iran. Methods: Records of elderly patients (aged 60 and older) admitted with acute burns tothe Burn Center of the Shahid Motahari Hospital, Tehran, Iran, between March 2007and March 2014 was carried out. Patient demographics, etiology of burn, mechanism ofinjury, burn extent, mortality, severity of burn, length of stay in hospital, and outcomeswere reviewed. The information was analyzed by SPSS software, version 18 (SPSSInc., Chicago, IL, USA). T-test, oneway anova and K square were used. Results: A total of 374 elderly patients were admitted. Majority of the patients weremen 231 (61. 8%) and the number of women were 143(38. 2%). The most commonetiologies were scalds (20. 3%) and (oil-benzine-gasoline) (19. 8%). The mean age of thepatient was 71. 5 years, which was average in women (72) and men (70. 5 years). Therewas a statistically significant difference between the mean age in both male and femalegroups, so that the mean age of women was significantly higher than men (P=0. 004). There was a significant correlation between gender and (etiology, hospital staymortality)and between treatment outcome and (etiology and motivation) and betweenmotivation and etiology (P<0. 001). Conclusion: Boiling water was the main cause of burning in older women. Diminishedsenses, concentration disorders, slower reaction time, reduced mobility, and bedriddenstates may decrease elder's ability to identify fire and also to escape harm.

Background: Tariff setting in healthcare is an important control knob affecting thequality, access and cost of services. As part of Iran Health Transformation Plan (HTP)in 2014, the relative value of health care and services was increased to motivatehealthcare providers to deliver high quality services. This study aimed to examine theimpact of HTP on health services tariffs. Methods: This descriptive and cross-sectional study used the data from CaliforniaTariff Book (2013 edition) and the new relative value book (2016 edition). Theweighted average of the relative value of the anesthetic and surgical services in bothbooks was calculated and compared. Results: The California book and the new relative value book had 5281 and 3448service codes respectively in 13 major medical specialties (34. 7 percent reduction ofservice codes in the new tariff book). Overall, 64985. 9 K and 125133. 6 K wereconsidered in the California book and the new relative value book (92. 6% growth). TheCalifornia book and the new relative value book considered 25, 976 K and 22, 307 K foranesthesia services, respectively in those 13 medical specialties (14. 1% reduction). TheHTP has increased the relative value of healthcare services tariff by 1. 9 times inaverage. Conclusion: The HTP has doubled the tariff of healthcare services. A rise in therelative value of healthcare services has incurred financial burden on Iranian publichealth insurance companies and made it difficult to finance health system of thecountry. A sustainable health financing system should be developed as well a changeshould be applied in provider payment system to control the cost and increase the healthsystem efficiency.

Background: Various prediction models have been developed aiming to estimate riskadjustedmortality, morbidity and length of intensive care unit stay following cardiacsurgeries. The European system for cardiac operative risk evaluation II (EuroSCOREII) is a prediction model which maps 18 predictors to a 30-day post-operative risk ofdeath. The objective of this study was to evaluate the performance of the EuroSCOREII risk-analysis predictions among patients who underwent heart surgeries. Methods: A prospective cross-sectional study was conducted to collect requiredvariables for all consecutive patients underwent heart surgeries in Emam Reza hospital, Mashhad, Iran, from March 2014 to March 2015. Once the patient was hospitalized acardiologist or a general physician evaluated pre-peri-and post-operative state to fillout the pre-designed structural paper form. Comparing the observed and expectedmortality, the sensitivity, specificity, area under the receiver operating characteristiccurve (AUC) and finally the discrimination power of the model for our patients werecalculated and reported. The model value was calculated using the online tool. Results: A total of 1337 patients (60% males) were included, the observed mortalityrate was 3. 2%. Although the overall performance was acceptable, the model showedpoor discriminatory power (AUC=0. 667, CI 95%: 0. 648-0. 685) and accuracy withsensitivity=61. 88% and specificity=66. 23%. Conclusion: Our single-center study, based on consecutive patients who underwentcardiac surgery showed that EuroSCORE II demonstrated a moderate statistical overallperformance with poor discrimination and calibration measures remain as concerningissues regarding 30-day post-operative mortality prediction after adult cardiac surgery. Poor performance measures for this system show the need for reformulating this riskstratification tool aiming to improve post cardiac surgery outcome predictions in Iran.

Background: Acute leukemia is one of the most common types of childhoodmalignancies and one fourth of malignancies in this age group is acute leukemia. Acute leukemia may be myeloid or lymphoid. Acute lymphoblastic leukemia ischaracterized with abnormal proliferation of lymphoid cells and symptoms related tothis are acute and if disease is not treated appropriately, it progresses rapidly and endup to death. Diagnosis of these types of malignancies is easily made with evaluationof bone marrow and peripheral blood cells by an expert hematologist. One of theprimary sites of leukemic involvement in childhood is oral cavity which is caused byinfiltration of leukemic cells in this area. This causes signs and symptoms, forinstance, oral lesions gingival hemorrhage and swelling. Case presentation: We present a 13-year-old girl who was referred to local physiciandue to toothache and gingival lesions. Some medications were prescribed for herwithout any improvement. Then excision of this painful gingival lesion was done anddiagnosis of acute lymphoblastic leukemia was confirmed. After diagnosis and startof appropriate medical therapy, patient developed many different complications ofacute lymphoblastic leukemia and its related therapies. What make this presentedcase as an outstanding and interesting one is the mentioned complications whichwere more significant with multiple organ involvement in comparison with similarcases. These complications were treated by appropriate managements. Conclusion: With new advance in treatment of ALL, survival rate of patients isincreased but unfortunately morbidity rate is significant. These complications maybe managed by appropriate therapies and close follow-up.