Tehran University Medical Journal
Year:2019 | Volume:76 | Issue:12|Papers Count:10

In recent years, the use of gold nanoparticles (GNPs) in radiation therapy has been studied by experimentation and Monte Carlo simulation repeatedly. Although the idea of increasing doses has been raised by high-atomic elements since decades ago, but due to the adaptation of gold nanoparticles with the biological system, scientists have incited more about the various uses of these materials in radiation therapy. The results of all studies in this field are consistent with the increase in tumor-derived doses with gold nanoparticles in radiotherapy. But the results of the interaction of radiation energy are still controversial with the size of gold nanoparticles. In other words, in the Monte Carlo simulations the gold nanoparticles with a size of about 10 to 100 nm, and in biological studies, the nanoparticles with a dimension of 1. 9 nm were used. On the other hand, some studies of energy dependence have been developed in dose enhancement, and in some other studies the effect of the size of gold nanoparticles has been investigated on photon energy. However, in some respects, the results of radiation therapy using by gold nanoparticles does not appear to be definitive, although the photoelectric effect in low energies is considered to be the dominant phenomenon. The main idea behind the GNP dose enhancement in some studies is not able to explain the results especially in recent investigation on cell lines and animal models radiation therapy using GNPs. With the rapid development of nanotechnology in the biomedical field, GNPs have been widely used in the diagnosis and treatment for disease. Numerous pre-clinical studies in vitro and in vivo have proved the potential value of metalbased GNPs as radio sensitizers in cancer treatment. Various studies have indicated that radio sensitizing ability could be influenced by nanomaterial size, concentration, surface coating, and the radiation energy. Hence, gold nanostructures provide a versatile platform to integrate many therapeutic options leading to effective combinational therapy in the fight against cancer. In this review article, the recent progress in the development of gold-based NPs towards improved therapeutics will be discussed. A multifunctional platform based on gold nanostructures with targeting ligands, therapeutic molecules, and imaging contrast agents, holds an array of promising directions for cancer research.

Anaplasma phagocytophilum is a gram-negative intracellular bacterium that transmitted by hard ticks. A. phagocytophilum infect and multiply in the organs of ticks, in particular the salivary glands which enable the transmission to vertebrate hosts during feeding. The tick becomes infected by feeding on an infected host and there is transstadial but not transovarial passage of the organism. The majority of ticks are infected with the organism in enzootic areas. There are strains of A. phagocytophilum that have biological and ecological difference, including variations in host pathogenicity, vectors and geographical distribution. The organism has an interesting feature to grow in neutrophils by stopping the antibacterial activity of neutrophils. The bacterium is able to survive in the immune host, using complex mechanisms of antigenic variation. A. phagocytophilum infects humans and various animal species including dogs, sheep, cows, horses, wild deer and rodents. The disease is known as human granulocytic anaplasmosis in humans, canine granulocytic anaplasmosis in dogs, equine granulocytic anaplasmosis in horse and tick borne fever in ruminants. Cattle tick borne fever caused by A. phagocytophilum is characterized by high fever, reduced milk yield, inclusions in circulating neutrophils, leukopenia, abortions, reduced fertility, coughing, respiratory signs and swelling of the hind limbs. Clinical signs of human occur a week after the tick bites, the disease usually presents as an acute, sometimes fatal febrile syndrome, illness characterized by headache, chills, myalgias, arthralgia, malaise, and hematological abnormalities, such as neutropenia, lymphocytopenia, thrombocytopenia, leukopenia, and elevated hepatic aminotransferase levels and may lead to death. In this review article the history, bacteriology, epidemiology, pathogenesis, diagnosis, treatment and prevention of the disease caused by A. phagocytophilum is written based on the latest scientific findings. Several hard tick species are distributed in Iran and they are the most important ectoparasites of animals. A. phagocytophilum has been detected not only in Ixodes ricinus but also in cattle and sheep of Iran using molecular techniques. However, despite the zoonotic potential of the agent, there is no evidence in the identification of A. phagocytophilum in humans, and it seems necessary to research on the prevalence and epidemiology of the disease in the human population.

Background: Asymptomatic hemorrhagic transformation infarct (AHTI) is known as a complication of ischemic attack and maybe occurs in the entire stroke. However, the role of AHTI in the result of the treatment is still not clear, because it is based on the definition of an asymptomatic and not identifiable. The aim of this study was assessment and evaluation frequency of AHTI in acute ischemic stroke patients. Methods: This prospective cross-sectional study was done in Neurologic Department, Tehran University of Medical Sciences, Tehran, Iran, from April 2015 to April 2016. Second evaluation was done about new neurologic signs and symptoms ten days after stroke. In addition, brain CT scan was used to diagnose of hemorrhagic event in infarct area. If the hemorrhagic event was occur in different area, the patient was consider as a non-hemorrhagic transformation and excluded from the study. Other exclusion criteria include intracranial hemorrhage (ICH), trauma to the head during admission, cerebral vein thrombosis, coagulation disorder, anti-coagulant (heparin, warfarin) administration, induced transformation within 10 days of onset of ischemia, lacunar ischemic and unobservable in thirty T-brain scan, patient's lack of referral for examination and CT scan 10 days after the onset of symptoms, died before CT was considered. Results: Three hundred and eighty seven patients had inclusion criteria. 249 cases were excluded due to lost following, vein thrombosis of the brain, lacunar ischemia, anticoagulants recipient (heparin, warfarin), asymptomatic hemorrhagic transformation and death. Finally, 138 cases (86 men, 52 women) with 66. 61± 9. 37 years (50-101 years) were participated in data analysis. Frequency of positive CT scan was evaluated for ischemic stroke evidence in two stages. Of the 138 patients who participated in the study, 75 (54. 3%) were positive in the first and 63 (45. 7%) cases in the second time. 27 cases (19. 6%) had AHTI. Conclusion: Coronary artery bypass graft (CABG) had significant correlation with ATHI in acute ischemic attack. However, stroke history correlated with decreasing of ATHI. Concerning smoking and consuming the results showed that smoking did not affect the asymptomatic hemorrhagic transformation. Also, the results showed that the use of aspirin and Plavix also had no significant effect on increasing the incidence of ATHI.

Background: In the last 10 years, co-infection of human immunodeficiency virus/human T-cell leukemia virus-1 (HIV/HTLV-1) has emerged as a worldwide health problem. These viruses has the same route to infect human but different effects on CD4 positive T-cells. There was controversial results about the influence of coinfection HIV/HTLV-1 pathogenesis. This study compared clinical course and laboratory findings in HIV/HTLV-1 co-infection with HIV mono infection. Methods: This historical cohort study carried in Mashhad Consultation Center of Infective and Behavior Diseases, Mashhad, Iran, from April 2013 to March 2017. Persons who referred evaluated by the enzyme-linked immunosorbent assay (ELISA), then patients with positive ELISA test rechecked by ELISA and Western blot. Platelet count, WBC count, neutrophils count, positive CD4 T-cells, staging and disease severity evaluated at diagnosis, in starting and after of antiretroviral therapy in mono and co-infected patients. Demographic characteristics, including age, educational level, occupational state, marriage situation, past medical history and high-risk behaviors were extracted from the files. Results: Of 64 patients enrolled in this study, 61 persons were male. Of 64 participants patients, 42 persons were infected with HIV (35 persons of them were positive for hepatitis C virus), other 22 positive HIV cases, were co infected by HTLV-1 too (18 persons were positive for hepatitis C virus (HCV). Co infected patients had more history of high-risk situations specially intravenous drug abuse. The most common opportunistic infections was cryptogenic tuberculosis (TB), candidiasis and military TB. Opportunistic infections and lab findings (except for CD4 positive T-cell) were the same in both group. Clinical severity and disease staging did not differ significantly between two groups. Death was more common in co-infected group. Conclusion: Clinical course in human T-cell leukemia virus-1 (HTLV-1) co-infection has not obvious differences with previously HIV patients compare with only HIV infected patients. In co-infection with the onset of treatment the increase in the level of CD4 positive cells was higher than that HIV infection.

Background: Contact lenses are transparent, thin plastic disks that cover the surface of the cornea. Appropriate lens prescription should be performed properly by an expert to provide better visual acuity and reduce side effects. The lens administration is a multistage, complex and time-consuming process involving many considerations. The purpose of this study was to develop a decision support system in the field of contact lens prescription. Methods: In this fundamental study, data were collected from 127 keratoconus patients referred to the contact lens clinic at Farabi Eye Hospital, Tehran, Iran during the period of March 2013 to July 2014. Five parameters in the contact lens prescribing process were investigated. Parameters were collected as follows. “ Lens vertical position” , “ vertical movement of the lens during blinking” and “ width of the rim” in the fluorescein pattern were obtained by recording videos of the patients while wearing the lens. “ Fluorescein dye concentration” under the lens was evaluated by the physician and “ patient comfort” was obtained by asking the patient to fill a simple scoring system. Approved and disapproved lenses were judged and recorded based on the decision of an expert contact lens practitioner. The decision support system was designed using artificial neural networks with the mentioned variables as inputs. Approved and disapproved lenses are considered as system outputs. Artificial neural network was developed using MATLAB® software, version 8. 3 (Mathworks Inc., Natick, MA, USA). Eighty percent of the data was used to train the support vector machine and the rest of the data (20%) to test the system's performance. Results: Accuracy, sensitivity and specificity, calculated using the confusion matrix, were 91. 3%, 89. 8% and 92. 6% respectively. The results indicate that the designed decision support system could assist contact lens prescription with high precision. Conclusion: According to the results, we conclude that hard contact lens fitness could be evaluated properly using an artificial neural network as a decision support system. The proposed system detected approved and disapproved contact lenses with high accuracy.

Background: Hospital accreditation is an external evaluation of a hospital’ s structures, processes and results by an independent professional accreditation body using preestablished optimum standards. Accreditation has an important role in improving the quality, safety, effectiveness and efficiency of hospital services. This study aimed to examine the effects of hospital accreditation program from hospitals managers’ perspective. Methods: This descriptive and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire designed to examine accreditation effects on hospital performance, hospital employees, patients, and the society. The study population consisted of 914 hospital managers in Iran. Overall, 547 hospital managers were surveyed through stratified random sampling. Results: About 71% of hospitals achieved grade one and above accreditation status. The mean score of accreditation positive effects in hospitals was 3. 16± 0. 66 out of 5 (Average). Almost 38% of managers were satisfied with the accreditation results in their hospitals. Hospital accreditation program was successful in improving patient and staff safety, reducing medical errors and enhancing staff competencies. Its success in improving communication, promoting organizational culture, continuous quality improvement, resource utilization, and reducing nosocomial infections and hospital mortality rates was moderate. Accreditation was less successful in improving staff satisfaction, getting physicians involved in process improvement, practicing evidence based medicine, attracting patients and increasing hospital income. A statistically significant correlation was found between hospital size and accreditation results (P=0. 038, r=-0. 090). There was no correlation between using quality management models and getting better accreditation results (P=0. 085). However, there was correlation between using accreditation consultants and positive accreditation results (P=0. 045, r=-0. 087). Utilizing hospital resources, organizational learning, continuous quality improvement and effective communication had the most effect on accreditation success. Conclusion: The accreditation program had a moderate effect on hospital performance. It is costly to implement accreditation standards in hospitals. Hence, changes should be made to the accreditation system including accreditation standards and methods in order to have more positive effects on the staff and hospitals’ performance.

Background: Using alcohol is one of the most important death factors that can be prevented. Lifestyle-related diseases are at the top cause of mortality and burden of disease, whereas most of them can be prevented. Considering the growing importance of diseases related to lifestyle (including alcohol abuse), providing evidence-based clinical guidelines for diseases and life-style related conditions which are in accordance with the newest scientific findings and with cultural and economic conditions in each country are required. The aim of this study was to develop a clinical guideline for prevention and control of alcohol consumption. Methods: The type of study is initiation of a method or a scientific/administrative system (health system management studies) that uses the National Pattern of Localization of Clinical Guidelines in 2017 in Taleghani Hospital of Shahid Beheshti University of Medical Sciences, Tehran, Iran, by using the reviewed clinical guidelines, which was conducted by the end of 2017 based on organizational criteria, the availability of the full version of the clinical guideline and its up-to-datedness, and the appraisal of guidelines for research and evaluation (AGREE) scoring system. This clinical guideline was developed based on 5A Model (Assess, Advise, Agree, Assist and Arrange). Results: In order to prevent and control alcohol abuse, a clinical guideline was developed based on five clinical guidelines including United States Preventive Services Task Force (USPSTF), Healthy lifestyle guideline (ICSI), the guidelines for preventive activities in general practice in Australia (RACGP), The Australian population health guide to risky behavioural risk factors in general practice (SNAP), and the guidelines related to lifestyle and wellbeing by the National Institute of Clinical Excellence of England (NICE) in the form of 5A model. Conclusion: The best practice is according to the existing clinical guidelines for prevention and control of alcohol use screening, brief intervention (1-2 sessions) and behavioral counseling, treatment with cognitive behavioral interventions (2-6 sessions) and, if necessary, referrals to higher treatment centers. Referral is recommended for patients who have signs of substance dependence and need a level of care beyond brief service.

Background: Leishmaniasis is a zoonosis disease. About 350 million people are at risk of developing a disease, with 1. 5 to 2 million new cases every year in the world. The aim of this study was to determine the space-time clusters of cutaneous leishmaniasis in north of Khuzestan Province, Iran. Methods: In this cross-sectional study, the annual cutaneous leishmaniasis incidence per 100, 000 individuals in each county was determined for the past five years, reported from 2011 to 2015 in North of Khuzestan Province, Iran. Geographical information system (GIS) and spatial scan statistic method were used to identify spatial clusters of cutaneous leishmaniasis cases at the county level. Pure retrospective temporal analysis scanning was performed to detect the temporal clusters of cutaneous leishmaniasis cases with high rates using the discrete Poisson model. The space-time cluster was detected with high rates through the retrospective space-time analysis scanning using the discrete Poisson model. Results: The overall cutaneous leishmaniasis incidence increased from 2011 to 2015. A total of 3 high-risk counties were determined through Local Moran’ s I analysis from 2011 to 2015. Local Moran’ s I enabled the detection of the spatial autocorrelation for a county with its adjacent county. The method of spatial scan statistics identified different 11 significant spatial clusters. The space-time clustering analysis determined that the most likely cluster included 11 counties, and the time frame was October 2014. The secondary cluster included one counties in October 2014. The tertiary cluster included six counties, and the time frame was from June 2014 to November 2015. Conclusion: Spatial and temporal clusters of cutaneous leishmaniasis have increased in the northern region of Khuzestan Province, and most clusters have occurred in November.

Background: Diabetes mellitus has several complications. The Late diagnosis of diabetes in people leads to the spread of complications. Therefore, this study has been done to determine the possibility of predicting diabetes type 2 by using data mining techniques. Methods: This is a descriptive-analytic study that was conducted as a cross-sectional study. The study population included people referring to health centers in Mohammadieh City in Qazvin Province, Iran, from April to June 2015 for screening for diabetes. The 5-step CRISP method was used to implement this study. Data were collected from March 2015 to June 2015. In this study, 1055 persons with complete information were included in the study. Of these, 159 were healthy and 896 were diabetic. A total of 11 characteristics and risk factors were examined, including the age, sex, systolic and diastolic blood pressure, family history of diabetes, BMI, height, weight, waistline, hip circumference and diagnosis. The results obtained by support vector machine (SVM), decision tree (DT) and the k-nearest neighbors algorithm (k-NN) were compared with each other. Data was analyzed using MATLAB® software, version 3. 2 (Mathworks Inc., Natick, MA, USA). Results: Data analysis showed that in all criteria, the best results were obtained by decision tree with accuracy (0. 96) and precision (0. 89). The k-NN methods were followed by accuracy (0. 96) and precision (0. 83) and support vector machine with accuracy (0. 94) and precision (0. 85). Also, in this study, decision tree model obtained the highest degree of class accuracy for both diabetes classes and healthy in the analysis of confusion matrix. Conclusion: Based on the results, the decision tree represents the best results in the class of test samples which can be recommended as a model for predicting diabetes type 2 using risk factor data.

Background: Cervical pregnancy is a rare type of ectopic pregnancy (EP) in which the pregnancy implants in the lining of the endocervical canal. It accounts for less than 1 percent of ectopic pregnancies. The cause is unknown; local pathology related to previous cervical or uterine surgery may play a role given an apparent association with a prior history of curettage or cesarean delivery. The most common symptom of cervical pregnancy is vaginal bleeding, which is often profuse and painless. Lower abdominal pain or cramps occur in less than one-third of patients; pain without bleeding is rare. It is important to think about the possibility of cervical pregnancy in such patients since early diagnosis is critical to avoidance of complications and successful treatment. Management of this pregnancy is dependent on the hemodynamic status of the patient. Conservative management and some more aggressive therapy such as emergency hysterectomy can be used. The aim of this report was to introduce a case of successful conservative management of cervical pregnancy. Case presentation: A 30-year-old G2L1 woman with history of a previous cesarean section and possible diagnosis of missed abortion referred to the Gynecology Clinic of Ghaem Hospital, Mashhad University of Medical Sciences, Iran, in 21 May 2017. Cervical pregnancy was diagnosed during curettage. Severe hemorrhage occurred after curettage and the hemodynamic status of the patient was unstable immediately after curettage. Severe threatening vaginal bleeding was controlled with intrauterine Foley catheter containing 60 cc normal saline and then vaginal packing. The patient was discharged with good general condition. Conclusion: In cervical pregnancy and unstable hemodynamic status and desire to preserve fertility, intrauterine Foley catheter and vaginal packing after curettage is helpful.