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Introduction: Nearly, 6% of recently diagnosed cancer in the United States was upon to lymphoproliferate and leukemia and 9% of fatality in cancerous people was upon to these two illnesses. Using some simple, cheap and in-hand tests and special consideration to clinical inspections in suspected subjects provide a faster diagnostic and suitable treatment. It may ultimately promote the quality of life and decline the fatality among patients.
Materials and methods: This was a cross-sectional investigation which carried out during a 1.5 years in the form of forward direction. Forty-two lymphoproliferate (28 lymphoblast and 14 Hotchkin) and 21 acute lymphoblastic leukemia (10 acute lymphoblast leukemia and 11 miloid acute leukemia) subjects were evaluated. ESR, LDH and ALP levels were measured in all patients. In clinical examinations, oversizing of lymph nodes, spleen and liver were exactly considered.
Results: According to our results the best tests to rule in and rule out acute leukemia from lymphoprolifeatives were ESR and LDH, respectively. Additionally, The most sensitive and specific evaluations to rule out these two diseases were LDH and oversizing of liver inspection. It was also determined that LDH is the best screening test to rule out leukemia from lymphoproliferate.
Conclusion: Using of simple examinations such as ALP, LDH, ESR and more consideration to oversized spleen, liver and lymph nodes in each suspected patients, we could easily differentiate lymphoproliferate and acute leukemia from each other.

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Introduction: Oculogyric crisis which is a dystonic reaction, is commonly caused by neuroleptics and rarely occurs with atypical antipsychotics specially Clozapine. In this article a case of Clozapine induced oculogyric crisis is reported. Case: The patient was a 25 years old woman with auditory hallucination, loosening of association and persecutory delusion that was admitted and treated. Because of poor response to typical antipsychotics, Clozapine was prescribed. Then she experienced multiple episodes of oculogyric crisis and was treated successfully with anticholinergic medication (Artane). Conclusion: In this special case, Clozapine caused oculogyric crisis. This side effect is rare but should be considered as a possible adverse effect of Clozapine. On the basis of this report, Clozapine induced oculogyric crisis may be treated successfully with Artane

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Background: Delay in treatment of acute myocardial infarction has an important effect on developing the myocardial damage and the prognosis of the patients. In this study, interval between the onsets of symptoms until hospitalization was studied on patients who reffered to fatemeh Zahra hospital of Bushehr port. Methods and Materials: This is a cross-sectional analytic study, carried out on 120 patients, with acute heart attack in Bushehr hospital by using a sampling during 9 month period. A questionnaire was used consisted of three sections: first demographic information second, questions about time Interval between the Beginning symptoms to hospitalization and third questions about cause of delay that it was completed by inteviwe method. Results: Results showed that the total length of time between the onset of symptoms and hospitalization EU was 273/33±259 minutes. There was significant relation between positive family history, past history of CAD, having insurance, chief complain, going to physician clinic before hospitalization and age with the delay timed (P<0.05). The most common cause of delay was lack of knowledge about symptoms and inattention toward their importance. Conclusion: Time Interval between the onsets of symptoms to hospitalization approximately was 4.5 hours that was not acceptable. Findings indicate developing educational approaches to increasing patient’s knowledge is necessary for better understanding of symptoms in the onset of MI that hereby with the delay time reduces.

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Background: Nowadays, the use of inflammatory biomarkers in the diagnosis of appendicitis is on the rise. On the other hand, the role of oxygen free radicals in various inflammatory states has been verified. Noticing the high prevalence of negative appendectomy (9.3-22.2%), the aim of this study was to investigate the level of blood total antioxidant capacity (TAC) as a biomarker for early diagnosis of acute appendicitis. Materials and Methods: In this prospective analytical trial, over a one-year period, 407 patients, with preoperative diagnosis of acute appendicitis who had undergone operation, were studied. After measuring the TAC level, data were analyzed through the analytic ROC curve and parametric mean comparison tests. Results: Of all the patients, 298 were identified with appendicitis. TAC levels in adult female and male groups were respectively 663.9±164.75 and 752.58±167.37 µm/L which revealed a significant difference (p<0.0001). Also, in children, the mean of TAC level in perforated appendicitis sub-group was significantly greater than those in gangrenous and suppurative groups. Conclusion: TAC level can be used as a predictive factor for the diagnosis of perforated appendicitis in children however, it cannot be used as a biomarker for the diagnosis of appendicitis. Because of the significant difference existing between the level of TAC in male and female patients, further studies are suggested to investigate the level of inflammatory biomarkers with respect to menstrual cycle in women.

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Background: Diagnosis of acute appendicitis is one of the challenges that surgeons face in the emergency ward. Although Alvarado score has been recommended in the diagnosis of acute appendicitis, this criterion has some limitations in terms of age, sex, and race. The aim of this study was to evaluate the effectiveness of Alvarado score in the diagnosis of acute appendicitis based on the age and gender. Materials and Methods: In this cross-sectional study, 407 patients who underwent operation with the preoperative diagnosis of acute appendicitis from June 2008 to August 2009 were included in the study. The patients’ data were recorded by the investigators. The data were compared by parametric tests. The sensitivity and specificity were determined by the optimal cut-off point on ROC curve using MedCalc software version 10.2.0.0. Results: The optimal cut-off point for women was lower than men (6 and 7, respectively). The rate of negative appendectomy in the group with Alvarado scores 9 and 10 was 11.8%, while the negative appendectomy rate in the other two groups with Alvarado scores 7 and 8 and 5 and 6 were 29.9% and 52.8%, respectively. Conclusion: The diagnostic value of Alvarado score of 8 and less in physical examination is lower than the abdominal tenderness exam alone. Also, the cut-off point for the diagnosis of acute appendicitis in women should be considered lower than that in men. On the other hand, the cut-off point in adolescents and children is higher than adults.

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Background: APACHE IV scoring system is one of the most useful scoring systems for evaluating the quality of health care services in ICU. The aim of this study was to evaluate the quality of health care services in ICU wards of Valiasr and Amiralmomenin Hospitals of Arak. Materials and Methods: This cross-sectional study was conducted on 100 patients admitted to ICU wards in Valiasr and Amiralmomenin Hospitals of Arak. First, the predicted mortality and length of stay (LOS) in ICU were calculated by APACHE IV scoring system. Then the real mortality and the real length of stay in ICU were recorded. Data were analyzed by SPSS software version 11.5 and t-test. Results: Real mortality in men and women were 57.2% and 61.9%, respectively. The real length of stay in men and women were 11.58 and 11.62 days, respectively. Predicted mortality calculated by APACHE IV in men was 23.72% while it was 24.1% in women. Predicted LOS by APACHE IV in men was 15.02 days while it was 16.64 days in women. There was a significant difference between real mortality and predicted mortality (P = 0.001). Conclusion: The findings of this study indicate that the quality of health care services in ICU wards of Valiasr and Amiralmomenin Hospitals of Arak are far from international standards.

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Background: To date, several drugs have been proposed for the treatment of acute promyelocytic leukemia (APL) however, none of them has resulted in complete remission. Therefore, many efforts are in progress to find new drugs with the capability of inducing apoptosis. Recently, anti-carcinogenic effects have been reported for a drug named carbenoxolone (CBX) on several cell lines. In the present study, the effects of CBX on NB4 cell line, as an experimental model of APL, were examined. Materials and Methods: In this trial, NB4 cell line was cultured and treated with different concentrations of CBX (50-250µM) in various time intervals (12-48 hours). Trypan blue exclusion test was used to evaluate growth inhibitory and viability effects of the drug on NB4 cell line. Fluorescent microscopy (acridine orange/ethidium bromide double-staining) and agarose gel electrophoresis DNA were used to study apoptosis. Results: CBX induced growth inhibition of NB4 cells so that growth inhibition rates of NB4 cells, after the 48 hour of treatment with 50, 100, 150, 200, and 250 µM CBX were 32.65, 47.52, 60.73, 68.91, and 74.33%, respectively. Furthermore, the results of DNA fragmentation and fluorescent microscopy assays indicated that apoptosis is a major mode of cell death after treatment of NB4 cells with above concentrations of CBX. Conclusion: Noticing the growth inhibitory and apoptotic effects of CBX on human promyelocytic leukemia NB4 cells, it can be considered as a potential candidate for further studies on APL treatment.

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Background: Because of high mortality and morbidity of severe acute pancreatitis (AP) and its increasing incidence in recent years, early detection of severity of AP is very important. Since interleukin (IL) rapidly responds to body temperature changes, this study was done to examine the relationship between blood levels of interleukin 15 and 17 and severity of acute pancreatitis. Materials and Methods: In this cross-sectional study, 52 patients with AP were studied. For all patients, paraclinical information, Ranson criteria, and APACHE-II were completed. Serum interleukin 15 and 17 levels were measured by ELISA method. Then the relationship between them and AP severity was determined based on Ranson criteria and APACHE-II. Results: In this study, 36.5% of the patients were male and 63.5% were female and the mean age was 61.06 years. The serum level of IL-17 was negatively correlated with the severity of AP based on Ranson criteria (p=0.021, r= -0.319). ROC curve showed significant values for blood level of IL-15 and CRP in AP diagnosis. Sensitivities were 92.3% and 78.8% and specificities were 40% and 48%, respectively. Conclusion: Based on Ranson criteria, the role of serum level of IL-17 as an unknown factor was seen significant in determining the severity of AP. However, the diagnostic value of serum IL-15 should also be verified with further studies.

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Background: Acute pancreatitis is a common cause of abdominal pain, without any characteristic signs, symptoms, or a gold standard diagnostic modality. The purpose of this study was to evaluate the diagnostic value of urine trypsinogen-2 strip test in acute pancreatitis. Materials and Methods: In this cross-sectional study, 76 patients with abdominal pain suspected to acute pancreatitis who were admitted to the Emergency ward of Valiasr Hospital, Arak, were evaluated. In 46 patients, acute pancreatitis was confirmed (pancreatitis group), whereas in 28 patients, acute pancreatitis was ruled out (control group). In both groups serum levels of amylase, lipase, CRP, and urine trypsinogen-2 were measured by quantitative and qualitative methods. Sensitivity and specificity of the tests were determined and data were analyzed using SPSS software. Results: Urine trypsinogen-2 dipstick was positive in 36 of the 45 patients in the pancreatitis group (sensitivity: 80%) and in 2 of the 28 patients in the control group (specificity: 92.8%). Urine trypsinogen-2 ELISA test was positive in 41 of the 45 patients in the pancreatitis group (sensitivity: 91.1%) and in 4 of the 28 patients in the control group (specificity: 89%). Amylase sensitivity and specificity were equal to 82.6% and 75%, respectively. Lipase sensitivity and specificity were 76% and 85.7%, respectively. Conclusion: Urine trypsinogen-2 dipstick can be used to differentiate acute pancreatitis from other causes of abdominal pain. This rapid, easy-to-use, and accurate test can be used in emergency wards and primary health care units with limited diagnostic facilities.

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Background: Several studies have demonstrated that the levels of inflammatory markers in healthy women are under the influence of menstrual cycle changes. The aim of this study was to compare blood levels of inflammatory markers in women with appendicitis in different phases of menstrual cycle. Materials and Methods: In this case-control study, 70 female and 12 male patients with appendicitis, and 61 healthy women were enrolled based on inclusion and exclusion criteria. Inflammatory markers, such as leukocyte count, CRP, ESR, and TNF-α were measured and compared using student t-test and one-way ANOVA based on different phases of menstrual cycle. Results: There were no significant changes in the ESR, CRP, and TNF-α concentrations and the number of peripheral blood leukocytes in different phases of the menstrual cycle in women with appendicitis. The mean number of leukocytes and CRP concentrations were significantly higher in patients with appendicitis compared with the control group. Conclusion: The findings show that there are not significant differences in the inflammatory markers in women with appendicitis during the different phases of menstrual cycles. It seems that day to day variation of sexual hormones in the menstrual cycle have led to very different conclusions about the change of inflammatory markers in different phases of menstrual cycle. Therefore, studies investigating inflammatory markers in women with acute appendicitis based on day of menstrual cycle, time of sampling in the day, and severity of appendicitis are suggested.

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Background: Leukemia is the most common type of cancer in children which its relapse decreases the patients’ survival rate. The aim of this study was to determine the risk factors involved in leukemia relapse in patients in Shahid Faghihi Hospital, Shiraz, during 2004-2009 years. Materials and Methods: In this retrospective cohort study, 280 patients with acute lymphoblastic leukemia and acute myeloid leukemia were included. Patient characteristics were analyzed with respect to their association with recurrence through Chi-square test, Fisher’s exact test, and logistic regression model using SPSS software version 16 (P-value<0.05). Results: Logistic regression model revealed a statistically significance relationship between age and recurrence of the disease (odds ratio (OR) = 0.35, 95% confidence interval (CI) = 0.15-0.82), odds ratio of relapse in the 5-10 years old age group was 0.35 times more than the 0-5 years old age group (p=0.01). Conclusion: Noticing the greater likelihood of relapse in 0-5 years old age group compared with the 5-10 years old age group, more attention and better follow-up for decreasing the side effects of the disease and enhancing the survival rate of the 0-5 y/o age group are recommended.

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Background: Since nearly 90% of patients with acute promyelocytic leukemia (APL) have high telomerase activity and significant shortened telomere length, these patients have, therefore, been suggested to be good candidates for the therapeutic intervention with telomerase inhibitors. This study was done to investigate the effects of BIBR1532, a non-nucleoside inhibitor of telomerase, on APL cells. Materials and Methods: In this experimental study, for investigating the effect of BIBR1532, NB4 leukemic cells were cultured in the presence of various concentrations of BIBR1532. Succeeding apoptosis assay, Caspase-3 activity assay, and quantitative real-time PCR were applied to examine the effect of this drug on apoptosis percenage, enzymatic activity of Caspase-3, and quantitative expression of genes mRNA involved in apoptosis. Results: The results showed that BIBR1532 induced apoptosis in NB4 cells in a dose-dependent maner. Moreover, real time PCR results showed that BIBR1532 led to a significant decrease in mRNA of Bcl-2 gene and signficant increases in transcription of Bax, PUMA, and Caspase-3. Conclusion: Since treatment with BIBR1532 could exert rapid apoptotic cell death in NB4 cells andactivate cellular apoptosis route, anti-telomerase-based therapy can regarded as a suitable strategy for APL treatment. Patients with progressive shortening of telomere length and high levels of telomerase activity are suitable candidates for treatment with telomerase inhibitors.

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Background: Osteopenia is a common and sometimes disabling consequence of the treatment of common neoplastic diseases, such as acute lymphoblastic leukemia (ALL) and lymphoma in children. The aim of the present study was to evaluate the preventing effects of alendronate on steroid-induced osteopenia in children with ALL and non- Hodgkin’s lymphoma (NHL).

Materials and Methods: In this clinical trial, 30 children with ALL and NHL were purposefully selected. All patients received the same induction chemotherapy protocol. Then they were randomly divided into two matched groups. All of them received equivalent supplement of 400 IU/d vitamin D and 30-40mg/kg/d calcium. The patients of the case group received 35mg/week alendronate for 6 months as well. Lumbar spine and whole body bone densitometry were performd before and after intervention and Z score was calculated for all patients.  

Results: The mean age of the studied population was 6.11(±3.36) years and 15 of the children (50%) were male. There was no statistically significant difference in lumbar spine and whole body bone densitometry and Z score before and after intervention between the two groups (p>0.05). The improvement of bone densitometry and Z score were seen in both groups after intervention which was more in the case group but it was not statistically significant (p>0.05).

Conclusion: Administration of 35 mg/week alendronate for 6 months does not cause significant improvements in bone densitometry variables in children with ALL and NHL.  

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Background: Multidrug resistance is the main reason for unsuccessful chemotherapy. The important reason of drug resistance is ATP dependent pumps shus as MDR1 that extrude drugs from the cell. MDR1 is high polymorphic. It seems that polymorphisms influent on gene expression and response to treatment. The aim of this study was investigation of C1236T polymorphism MDR1 gene and it’s association with response of treatment in childhood acute lymphoblastic leukemia.

Materials and Methods: In this descriptive study, C1236T polymorphism of MDR1 was investigated in 44 acute lymphoblastic leukemia childhood and 40 healthy individual by ARMS-PCR technique. Association of this polymorphism with response to treatment was also investigated. Data were analyzed using Chi-squre test and SPSS software. P values <0.05 were considered to be statistically significant.

Results: There was no significant difference in frequencies of C1236T polymorphism between patients and healthy group (p=0.876). Frequency of C1236T polymorphism of MDR1 between responder and non responder was not significant (p=0.304).

Conclusion: It seems that there is no correlation between C1236T polymorphism of MDR1 gene and response to treatment. So the role of C1236T polymorphism in gene expression MDR1 in childhood acute lymphoblastic leukemia and response to treatment is still controversial.

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Background: Sudden visual loss is one of the emergent problems that it may be a sign of a life-threatening disease. It should be quickly evaluated and identified the treatable causes.

Case report: A young man without any history of certain disease was referred to the emergency department with complaints of sudden blindness. He was presented with fever, coriza symptoms and progressive blurring of vision that ultimately led to his visual loss. After carefully evaluation, finally suspected diagnosis of acute fulminant multiple sclerosis was made.

Discussion: Multiple sclerosis is a chronic inflammatory disease that is associated with acute attacks of neurological dysfunction. Some of these attacks are an emergent situation and need to early detection and treatment. There is a variant of Multiple sclerosis that called Acute Fulminant Multiple sclerosis which can cause sudden visual loss.

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Background: Inflammation has an important role in the pathogenesis of atherosclerosis. The aim of this study was to evaluate the role of WBC (White Blood Cell) count and incidence of morbidity and mortality in patients with ACS.

Materials and Methods: This prospective study was carried out on 101 patients with ACS who admitted in Bu-ali Sina hospital. All patients were stratified according to WBC categories in to 3 groups, (WBC 1 :<7000 mm3, WBC 2:7000 -10000 mm3, WBC 3:> 10000 mm3). Demographic and laboratory data such as acute reactive protein, cardiac biomarker and etc. were recorded. Adverse cardiac events and mortality were recorded to a phone or in person for six months of follow up period. The collected data were analyzed using SPSS software (Statistical Package for Social Sciences, version 17.0). The Fisher´s exact chi-square test and the student t-test were applied. P-values less than 0.05 were considered significant.

Results: In our study, 5 patients (31.25%) in third group had recurrent non fatal cardiac event and the same percent (31.25%) were died after 6 months follow up. Multivariate analysis showed WBC count >10000 mm3 was strongest predictor of outcome in our patients.

Conclusion: WBC count can be considered one of the strong independent predictor of mortality and cardiac event in patients with ACS.

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Background: Doxorubicin is a chemotherapeutic agent still in widespread use in hematologic malignancies. A side effect of anthracyclines such as doxorubicin is the activation of nuclear factor-&kappaB (NF-&kappaB), a potent inducer of antiapoptotic genes, which may blunt the therapeutic efficacy of the drugs. In this study, the effect of indole -3-carbinol (I3C) on the activation NF-&kappaB and the anti-apoptotic genes whose expression is regulated by NF-&kappaB was assessed in NALM-6 cells.

Materials and Methods: NALM-6 cells were preincubated with various concentrations of I3C and then treated with doxorubicin. Cellular DNA content assay and Annexin V-FITC staining were performed by flowcytometry for evaluation of apoptosis. For assessing the effect of I3C on the expression of XIAP, survivin, and nuclear p65 proteins, NALM-6 cells were pretreated with I3C and then incubated with doxorubicin. Whole-cell and nuclear extracts were prepared for Western blot analysis. A paired t-test was conducted to evaluate the results.

Results: DNA histogram analysis of NALM-6 cells indicates a combination of I3C with doxorubicin significantly escalated the percentages of sub-G1 population cells compared with doxorubicin - only treated group (p<0.05). Annexin V-FITC staining also showed that cotreatment of NALM-6 cells with I3C and doxorubicin significantly increased the proportion of Annexin-V positive cells in comparison with the doxorubicin treated cells (p<0.05). The western blot analysis indicated I3C significantly inhibits both doxorubicin -induced nuclear translocation of p65 and the expression of doxorubicin-induced NF-&kappaB target.

Conclusion: Our results indicated that using natural non-toxic inhibitors of NF-&kappaB such as I3C in combination with anthracyclines might be a rational combination therapy for BCP-ALL cells in which NF-&kappaB is constitutively active.

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Background: Brucellosis is a highly contagious zoonotic disease between humans and animals known for high frequency of relapsing and ability to cause chronic infection. The function of immune system plays an important role in induction of chronic diseases. However, the role of immune system response is not completely studied. Therefore, this study designed to investigate the cytokine profile of the patients suffering from chronic and acute brucellosis.

 Materials and Methods: This descriptive- analytical study was performed on 22 patients with acute brucellosis (mean age 38±17), 21 patients with chronic brucellosis (mean age 43±10) and 21 healthy people (mean age 26±4) with the same age and sex as patients. The serum IFN-&gamma, IL-17, IL-5 and TGF- &beta levels were measured using ELISA method.

 Results: The mean IFN-&gamma serum level in acute and chronic brucellosis patients group was significantly higher than control group (p=0.045). The mean IL-17 serum level in acute brucellosis patients was significant decreased once compared with control group and in chronic patients was significantly decreased when compared with control group (p=0.024). In addition, the mean IL-5 and TGF-&beta serum levels of acute brucellosis patients group were significantly decreased as compared to chronic patients (p=0.001).

 Conclusion: The results of current study indicate that cytokine profile of chronic brucellosis patients is more related to Th2 immune response. Hence, Th2 immune response inhibition would be an appropriate way to treat and prevent disease to become chronic.

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Background: Brucella is an intracellular bacterium that causes chronic infection in humans and domestic animals. The underlying mechanisms that cause prolonged illness are complex and not fully understood. Immune responses may have an important role in the chronicity of infection. Here, we evaluated the lymphocyte proliferation responses in patients with chronic and acute brucellosis.

Materials and Methods: This descriptive - analytical study was performed on 22 patients with acute brucellosis, 21 patients with chronic brucellosis and 21 healthy people with the similar age, sex and genetic background as control group. Peripheral lymphocytes were isolated using Ficoll and the cellular proliferation was quantified in presence of antigen and phytohemaglutinin-A by MTT method.

Results: The brucella antigen-specific stimulation index in patients with chronic brucellosis was significantly lower than the acute brucellosis patients (p=0.001). Also, stimulating the lymphocytes with phytohemaglutinin-A has shown that proliferative response in patients with chronic brucellosis was lower than the other groups (p=0.04).

Conclusion: The results indicated that chronic brucellosis inhibits lymphocyte proliferation. This inhibition of lymphocyte proliferation may be due to the induction of anergy.

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Abstract

Background: Acute bronchiolitis is the most common lower respiratory tract infection in infant and one of their hospital admission reasons. Due to the high prevalence of the disease and unclear effectiveness of existing treatments, the present study was designed to evaluate the therapeutic effect of single dose of injected dexamethasone and inhaled epinephrine in patients with acute bronchiolitis treated with inhaled salbutamol.

Materials and Methods: In this double-blinded clinical trial, 90 infants with age of 2-24 months who were admitted to hospital with acute bronchiolitis were studied. All patients received inhaled salbutamol (0.15 mg/kg) and then were randomly assigned to three groups (n=30) of dexamethasone (0.6 mg/kg), inhaled epinephrine (0.15 mg/kg) and control (distillated water). Heart rate (HR) and respiratory rate (RR), arterial blood oxygen saturation (O₂ sat) and respiratory distress scores (RDS) of children at baseline, 30, 60,120 minutes and, 24 hours after intervention were recorded and compared between groups.

Results: The mean of HR, RR and RDS had significant improvement and the mean of O2 sat had significant rising trend and improvement during the study in all groups (p<0.05). The mean of HR in epinephrine group was upper than placebo in all measurements (p<0.001). RDS in epinephrine group was significantly upper than dexamethasone (p=0.002, CI95%=0.58- 2.69) and placebo (p=0.014, CI95%=0.27-2.8) 

Conclusion: Based on the result of present study, it seems that inhaled epinephrine or injected dexamethasone have no superiority to placebo in treating infantile acute bronchiolitis and their administration is not recommended.