Vol 58, No 1 (2020)


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    Chronic tinnitus is a disturbing condition that may affect different aspects of life. In this study, the therapeutic effect of electrical stimulation on chronic tinnitus was assessed. This was a clinical trial on 49 patients with persistent tinnitus for more than 6 months without a proper response to routine treatments. They were randomly allocated into two groups: the case group was treated with electrical stimulation for 6 sessions over 6 consecutive days, and the control group received a placebo. Before the intervention, one week and three months after the treatment sessions, patients were evaluated by comprehensive audiological assessments and hearing tests. The mean age of the participants was 40.37±9.32 and 41.35±9.24 in treatment and placebo groups, respectively. Tinnitus intensity was significantly decreased in the case group one week and three months after the treatment (P<0.05). Tinnitus handicap inventory score significantly decreased in the treatment group one week and three months after the treatment (P<0.05). There was no significant difference in tinnitus intensity after treatment, considering gender, age, tinnitus duration, and tinnitus type. Electrical stimulation could significantly reduce the severity of the tinnitus regardless of age, gender, duration, and type of tinnitus.

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    Fever is one of the most common clinical manifestations in children. During the early days of acute febrile illness, some decrease in hemoglobin levels occurs due to unspecified cause. 64 children aged 6 months to 12-year-old with a fever higher than 38° for more than one day and with a diagnosis of acute febrile illness were admitted. The values of MCV, ESR, CRP, and hepcidin were measured at baseline and then 7 to 10 days after the improvement of the fever. The levels of reticulocytes, LDH, and bilirubin were also measured in two stages. Data analysis was done using SPSS software. The mean hemoglobin level in the acute phase of febrile illness was significantly increased 7-10 days after discontinuation of the fever by 12.87±1.09 g/dl (P<0.001). The MCV level also significantly increased (P<0.001), and levels of CRP, ESR, LDH, bilirubin, and hepcidin showed significantly decreased during the convalescent phase compared to acute febrile phase, but the level of erythrocyte increased. The present study confirmed the decrease in hemoglobin in children with acute febrile illness. Increasing of bilirubin, LDH, hepcidin, level, and no bleeding was observed during acute febrile infection in children.

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    The outcome of inoperable rectal cancer treatment by chemotherapy, radiotherapy, and targeted therapy are still unfavorable. Carbogen is a combination of 98% oxygen and 2% carbon dioxide proven effective as chemoradiosensitizer. The aim of this study is to know the effect of concurrent carbogen and chemoradiotherapy in locally advanced rectal cancer by measuring the shrinkage of the tumor volume. The design of this study was randomized true experimental 2 groups pre and post-test-controlled design. Samples were patients with locally advanced rectal cancer. MRI of the pelvis before and 4-8 weeks after the chemoradiation were examined. A total of 28 subjects were randomized to 14 patients who received concurrent chemoradiation with carbogen (treatment group) and 14 patients chemoradiation (control) The tumor shrinkage in the treatment group (13.08 to 6.08 cm3) was significantly higher compared to the control group (18.00 to 12.83 cm3). Supplementation of carbogen to standard treatment chemoradiation for locally advanced rectal cancer significantly shrinkage the tumor volume.

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    Quality of life of patients in need of liver transplantation is impaired due to many reasons, and this affects the pre and post outcomes and complications of transplantation. Therefore, the aim of this study was to evaluate the effect of a care program on the quality of life of patients awaiting liver transplantation. This quasi-experimental study was conducted in 2017 on 117 patients awaiting liver transplantation in Imam Khomeini Hospital of Tehran. Based on entry criteria, the samples were selected purposefully, and their quality of life was evaluated. Then, a care program in 6 one-hour-long sessions for 2 months was implemented for them. This program was according to patients' needs, including disease and transplant process education with using multiple educational methods. The data collection tool was a quality of life questionnaire (1999), which was completed before and six weeks after the intervention. The results showed that the overall quality of life and its entire aspects improved after the implementation of care program in patients waiting for liver transplantation, and the most change was related to the aspect of systemic (P<0.01). Also, the demographic variables had no significant relationship with the aspects of quality of life. The results of this study indicated a positive effect of the care program on improving the quality of life of patients awaiting liver transplantation. Eliminating the problems of these patients requires the attention and support of planners and the cooperation of managers in order to develop care programs that can be used by healthcare professionals, especially nurses.

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    Breast cancer is the most prevalent Iranian female malignancy. Breast screening reduces the number of malignant breast diseases. We aimed to assess the results of the pilot breast cancer screening on early detection in female medical staff in Milad Hospital, Tehran, Iran. A cross-sectional study. Female medical staff from Milad Hospital, Tehran, Iran, were examined by a specialist in 2016. A checklist, including demographic data, was completed by the participants. If necessary, they referred to as sonography or mammography. Data were analyzed using SPSS software. Of 746 people enrolled, 137 had no pathological point, 609 had suspicious or positive findings that were referred for further investigation, 449 had normal findings, and 7 had suspicious mass and were biopsied, 6 were benign. One case had primary invasive cancer. Since screening for breast cancer helps to early detection of this disease, the implementation of cancer screening programs should be on the priority of health authorities.

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    Infection is presumed to have a rule in the promotion of asthma exacerbations, and in deterioration of the course of the disease, Chlamydia pneumoniae (C. pneumoniae) is claimed to be a possible cause for these two issues. To assess the positivity and the titer of C. pneumoniae IgG antibodies in relation to the state of asthma and its severity. 61 asthmatic patients aged 15-85 years (mean of 47.10±14.887), and 29 apparently healthy, nonasthmatic age and gender-matched volunteers (control group) were assessed as at Asthma and Allergy Clinic in Al-Sader Medical City in AL-Najaf province, Chlamydia Pneumoniae IgG ELISA Kit was used for the detection of IgG antibody to C. Pneumoniae in human serum to detect chronic infection, and Spirometric test was done, and the best results for FEV1 and peak expiratory flow rate (PEFR) were taken. IgG antichlamydial antibodies were positive in 21 (34.4%) of patients compared to 4 (13.8%) of controls, and the difference was significant with OR=3.281, the seropositivity in acute exacerbation was more than in stable asthmatic, 43.8% vs. 24.1% (P=0.029), seropositivity was nonsignificantly more in moderate and severe asthma as compared with mild asthma, a significant inverse correlation between IgG titer and pulmonary function test parameters (FEV1, PEFR) was observed as the FEV1 & PEFR values decrease with increase IgG titer. Chronic C. pneumoniae infection is common in adult asthmatics and correlated with exacerbations & increased severity and disturbed lung function.


Case Report(s)

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    Griscelli syndrome (GS) is a rare autosomal recessive disease that affects hair, skin, and immune system. Here, we describe an 8.5-month-old infant with multiple admissions due to fever, petechial purpura, and several recurrent vomiting episodes with a presumptive diagnosis of recurrent sepsis. He was born from parents with consanguineous marriage. The initial examinations revealed huge splenomegaly and hepatomegaly without any source of infection. Laboratory tests revealed a hemophagocytic lymphohistiocytosis (HLH) like a picture with a high blood level of ferritin in all episodes, but the bone marrow test result was normal. Although he had normal hair and skin pigmentation on physical examination, the accumulation of melanosomes was found in his hair shafts on microscopic investigations. Eventually, a genetic test revealed a mutation in the RAB27A gene, which confirmed GS-II diagnosis. Our case is the first case of GS-II from Iran without any apparent clinical features of GS, such as hypopigmented skin and silvery-gray hair. Therefore, a genetic test, together with the microscopic examination of hair and skin, is necessary for the diagnosis and confirmation of GS-II. Since GS-II is an autosomal recessive disorder and consanguineous marriages are popular in Iran, premarital genetic counseling is recommended for this region.

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    The Rh blood group system is a complex blood group which includes different antigen specificities such as c antigen. Anti-c antibody is associated with both acute and delayed hemolytic transfusion reactions as well as hemolytic disease of the newborn (HDN). Rh mediated hemolytic transfusion reactions (HTR) are mostly immunoglobulin G (IgG) mediated and results in extravascular hemolysis and delayed HTR (DHTR). However, we are presenting a case of acute intravascular hemolytic transfusion reaction due to anti-c in a patient with acute subdural hematoma. A 77-year-old woman was referred to our hospital with a loss of conscious and left-sided hemiparesis. After an emergency MRI, she was diagnosed with Acute Subdural hematoma, and an emergency craniotomy was performed. Since Acute Subdural hematoma is a neurosurgery emergency, laboratory technician performed an Immediate-spincrossmatchedd for blood bag to preserve time. During the transfusion of the first packed cell, the patient developed severe hypotension and tachycardia. Thus, the transfusion was stopped. Laboratory results raised the suspicion of an Acute Intravascular Hemolysis. Antibody identification revealed that the patient had an irregular blood phenotype (C2+/c-/E-/e3+/K-), and the presence of alloantigen-c Rh antibody confirmed the suspicion of HTR. In patients with multi transfusion history and pregnant women, pre-transfusion screening of irregular antibodies must be performed. The immediate spincrossmatchh must be prevented in patients with a history of multi transfusions, even in emergency situations.

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    Intrahepatic lesions of hepatocellular carcinoma (HCC) have been controlled by significant advances in treatment including chemotherapy, surgery, and ablative therapy. Consequently, the number of patients with extrahepatic metastatic lesions has increased including lung, regional lymph nodes, peritoneum and adrenal glands, but rarely to brain. The prognosis of brain metastasis remains poor with approximately <1 y of survival from the time of diagnosis. Although no guidelines for the brain metastasis of HCC have been developed to date due to the lack of the experiences and evidences, a molecularly targeted drug, sorafenib, have been used to treat extrahepatic lesions and shown the prolonged survival time. Therefore, the development of standard therapy for brain metastasis following the early diagnosis is essential by accumulating the information of clinical courses and evidences.