Vol 58, No 3 (2020)


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    Colorectal cancer and its treatment have short-term and long-term side effects for patients. One of the factors affecting these side effects is the nursing care method. This study was conducted to determine the effect of care based on the critical pathway on the duration of hospitalization, complications of the disease, and satisfaction with nursing care in patients with colorectal cancer. In a cluster-randomized controlled trial study, 70 patients with colorectal cancer were randomly selected from two hospitals of OMID (N=35) and GHAEM (N=35) in Mashhad, Iran. They were assigned to intervention and control groups. The data were collected using a characteristic of patients, and satisfaction questioner, a checklist of patient status and nursing performance, and analyzed by SPSS software version 18. There was a significant difference in the mean of satisfaction of patients from nursing care and length of hospital stay between pathway and routine care group (P<0.001). There were no significant differences between pathway and routine for the postoperative complications after 12 weeks of follow-up. Our study indicates that critical pathway care can increase the satisfaction of patients and decrease the duration of hospitalization. Future studies should investigate how to increase other clinical outcomes in the oncology wards.

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    Helicobacter pylori (H. pylori) is a spiral bacterium that infects the human gastric mucosa. Various clinical aspects of the infection may mirror distinctive forms of cytokine expression. It has a correlation with immune cell penetration to the gastric mucosa with numerous cytokines production and gastric inflammation. IL-1 and IL-8 are directly contribute to H. pylori effected gastritis. IL-32 is a pro-inflammatory cytokine categorized by the training of Immune cells activation which have a vital role in human immunity. H. pylori virulence and danger factors which are critical in gastritis such as the outer inflammatory protein (OipA) and the cytotoxin associated gene A (cagA). We aimed to study the IL-32 mRNA expression in H. pylori-positive and negative patients as well as its relation with bacterial cagA, oipA, and severity of gastritis. Endoscopic biopsies were taken from the antrum of 60 H. pylori-infected patients and 62 uninfected individuals.  Mucosal IL-32 mRNA expression was assessed by real-time PCR. With PCR the H. pylori virulence factors were evaluated. Showed that the mRNA expression of IL-32 levels were significantly lower in biopsies of H. pylori-uninfected patients compared to positive individual (p = 0.01). A straight communication between virulence factor oipA, cagA and heightening in IL-32 mRNA expression (p <0.001) was observed. Furthermore. IL-32 mRNA expression levels were approximately equal in both chronic and active gastritis (p = 0.1). IL-32 may have critical role in different situation like inflammation and severity of inflammatory changes in the gastric mucosa.

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    In acute lymphoblastic leukemia (ALL) patients treated with L-asparaginase, discontinuation of the drug occasionally occur due to severe drug complications or resistance, however, due to the high efficacy of this drug in the recovery of patients and the prevention of disease recurrence, resuming the drug regimen is preferred in most patients. What we did in this study was to evaluate and compare the effects of clinical outcomes in the two modes of continuing and discontinuing drug use. In this retrospective cohort study, all children with ALL who had been treated with L-asparaginase during the years 2005 to 2015 were included in the study and categorized into two groups receiving complete treatment regimen (n=160) and those who had to discontinue the drug due to appearing complications (n=9). The rate of relapse and mortality rate was determined and compared across the two groups with a median follow-up time of more than 5 years. 5-yrs Overall survival of all enrolled patients in the groups continued and discontinued was 91.4±2.5% and 71.4±17.1%, respectively (P=0.792). Also, 5-yrs event-free survival of the two groups was 75.8±3.5% and 71.4±17.1%, respectively (P=0.557. Relapse was revealed in 17.5% and 33.3% respectively and mortality in 16.9% and 0.0% (P=0.261). However, the overall prevalence of hypersensitivity reaction to the drug was significantly higher in those patients who discontinued their drug regimen (100% versus 24.4%, P<0.001). Hypersensitivity reaction to drugs may be an important factor in discontinuing L-asparaginase in patients with ALL. The discontinuation of L-asparaginase supplementation due to various complications such as hypersensitivity reactions may be effective in the survival of these patients. However, accurate determination of the effect of discontinuation of this drug on the outcome of children with ALL requires a more comprehensive study with more complicated cases.

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    Diabetes mellitus (DM) is one of the most common endocrine disorders. 90% percent of all diabetics are diagnosed with type 2 DM. DM is closely associated with various vascular diseases, and successful glycemic control prevents micro and macrovascular complications. Although there is data about the relation between glycemic control and left ventricle function, there is hardly any data about the relation between the right ventricular function. We analyzed the relationship between glycemic control and right ventricle function in type 2 DM patients free of clinical cardiovascular diseases (CVD). Patients were selected from the cardiology outpatient clinic. 53 patients formed the DM group; 51 patients formed the control group. All patients' demographic data were recorded. Biochemical tests and echocardiographic examinations were performed. RA and RV diameters were significantly higher in DM group (3.36±0.32 vs 3.13±0.34, P=0.015; 2.80±0.32 vs 2.56±0.22 P=0.005 respectively). Myocardial velocity during isovolumetric contraction (RV/IVV) and myocardial acceleration during Isovolumetric contraction (RV/IVA) were significantly lower in the DM group (14.4±3.17 vs 16.04±4.13 P=0,019; 3.25±0.75 vs 3.95±1,25 P=0.015). There was an intermediate negative correlation between RV/IVV and HBA1C (r=-0.406; P=0.036). HBA1C level was an independent risk factor for RV IVV (β=-0.406; P=0.036). It is shown that RA, RV diameter were significantly higher; RV/IVV and RV/IVA were significantly lower in diabetes mellitus patients free of CVD. Furthermore, there was a significant negative correlation between RV/IVV and HBA1C levels. HBA1C level was an independent risk factor for RV/IVV.

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    The purpose of this study was to evaluate the effect of preoperative administration of duloxetine on postoperative pain after laparoscopic myomectomy. In this double-blind clinical trial study, 57 patients aged 18-55 years with ASA I or II undergoing laparoscopic myomectomy involved. The case group received oral duloxetine 60 mg, and the control group received placebo 2 hours before the surgery. Pain scores, total analgesic consumption during 24 hours, recovery discharging time, nausea, vomiting, dizziness, and hemodynamic changes were recorded and compared between two groups. The pain severity was significantly lower in the case group at 2, 12, and 24 hours after the operation (P<0.05). There were no significant differences in dizziness, nausea, vomiting, systolic and diastolic blood pressure, and heart rate of patients between two groups before the surgery, 5 and 30 minutes after the induction, and after the recovery. Duloxetine administration prior to laparoscopic surgery myomectomy can reduce postoperative pain without inducing side effects in patients.

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    Previous investigations have indicated an association between modulation of developing the immune system with increased risk of autoimmune diseases such as type 1 Diabetes Mellitus (T1DM). Objectives: In the present study, we aimed to evaluate correlations between the positive history of blood group incompatibility, neonatal jaundice, and phototherapy with childhood type 1 DM. A case-control retrospective study was carried out in an Iranian Hospital in 2015. One-hundred subjects aged 1-15 years with T1DM were included as the case group. One-hundred healthy children were also considered as the control group. A questionnaire composed of demographic-clinical data was completed for each subject. Correlations between childhood type 1diabetes and some clinical risk factors were determined. One hundred cases with type 1 diabetes and 100 healthy control children entered the study. A significant association between maternal gestational diabetes mellitus and childhood T1DM was observed (P=0.05, OR=3.789). The history of neonatal jaundice in the case group was significantly higher than in the control group (P=0.02, OR=4.667). ABO incompatibilities in the case group were associated with 19 neonates with blood group A and 2 neonates with blood group B (mothers' blood group; O) (P=0.005, OR=7.397). In the case group, 29 of 38 cases with a history of jaundice had received phototherapy while in the control group, 19 participants had undergone phototherapy (P=0.126, OR=1.707). Results have indicated that neonatal Jaundice and ABO incompatibility could increase the risk of childhood T1DM. Moreover, maternal GDM should be considered as an increased subsequent risk of childhood T1D.

Case Report(s)

Letter to the Editor