Human bone marrow-derived mesenchymal stem cell: a source for cell-based therapy

The ability of mesenchymal stem cells [MSCs] to differentiate into many cell types, and modulate immune responses, makes them an attractive therapeutic tool for cell transplantation and tissue engineering. This project was designed for isolation, culture, and characterization of human marrow-derived MSCs based on the immunophenotypic markers and the differentiation potential. Bone marrow of healthy donors was aspirated from the iliac crest. Mononuclear cells were layered over the Ficoll-Paque density-gradient and plated in tissue cultures dish. The adherent cells expanded rapidly and maintained with periodic passages until a relatively homogeneous population was established. The identification of adherent cells and the immune-surface markers was performed by flow cytometric analysis at the third passage. The in vitro differentiation of MSCs into osteoblast and adipo-cytes was also achieved. The MSCs were CDllb [CR3], CD45, CD34, CD31 [PCAM-1], CD40, CD80 [B7-1], and HLA-class II negative because antigen expression was less than 5%, while they showed a high expression of CD90, and CD73. The differentiation of osteoblasts, is determined by deposition of a mineralized extracellular matrix in the culture plates that can be detected with Alizarin Red. Adipocytes were easily identified by their morphology and staining with Oil Red. MSCs can be isolated and expanded from most healthy donors, providing for a source of cell-based therapy

Comparison of the prevalence of anemia in the first, second and third trimester of pregnancy in a medical and educational center in Shiraz

The high rate of anemia in pregnancy is associated with complications of pregnancy and delivery; therefore, to assess the level of hemoglobin [Hb] in women who are at risk can prevent these complications. In this descriptive study, 108 pregnant women referred to a medical and educational center in Shiraz in 2006. They were enrolled in three different occasions: first trimester [10-14 weeks], second trimester [25-30 weeks], and third trimester [37-40 weeks]. The correlation of blood hemoglobin concentration with the risk of severe nausea, vomiting, and iron supplementation in pregnant women was estimated. Statistical analysis was done with SPSS 11.5 and Pearson correlation. The mean age of the participants is 25.74 +/- 5.66. In the first trimester of pregnancy 71.9% had normal hemoglobin level and 28.1% higher than normal with no case being anemic. In the second and third trimester of pregnancy, 29.2% of the subjects were anemic. The level of hemoglobin had positive correlation with the total amount of iron intake in the second trimester [p= 0.001 and r= 0.44], also in the third trimester [p< 0.001 and r= 0.46] and the whole pregnancy [p< 0.001 and r= 0.38]. This study indicated that despite regular intake of iron,%29.2 of the subjects had anemia. These findings emphasize the importance of treating these groups of patients and measuring levels of hemoglobin in each trimester together with reviewing other risk factors which are effective on anemia

Anemia and iron deficiency in adolescent school girls in Kavar urban area, southern Iran

Anemia is one of the most common public health problems especially in developing countries. We investigated the prevalence of anemia, iron deficiency anemia and related risk factors in adolescent school girls in Kavar urban area in southern Iran. A total of 363 adolescent school girls were evaluated by a cross sectional study. Socioeconomic demographic and related risk factors were obtained by a questionnaire. Hematological parameters and serum iron indices were measured. There were 21 cases of anemia [5.8%], 31 [8.5%] iron deficiency and 6 [1.7%] iron deficiency anemia. Most of anemic girls [85.7%] had mild anemia. MCV, TIBC, age, and BMI had statistically significant relationship with hemoglobin. Only parasites infestation in the last three months had a 6.83 times more risk of anemia than those without this history [95% CI, 1.66-28.11]. The prevalence of anemia and iron deficiency anemia in this study were substantially less than what reported in many other regions of Iran as well as other developing countries. It seems that related implemented strategies in the recent years have been successful. More especial attention to prevention of parasite infestation should be considered in this area

Primary splenic hodgkin's disease in a patient with chronic granulomatous disease, a case report

Here we report a 20-year-old male, a known case of chronic granulomatous disease [CGD], who presented with fever and splenomegaly. After splenectomy, primary splenic Hodgkin's disease was diagnosed. Immunohistochemistry confirmed the diagnosis [positive CD15 and CD30]. With chemotherapy, his fever was subsided and now after 6 months, he is doing well. Although primary immune deficiencies have been reported to show an increased tendency to develop malignancies, until now there has been no report of a patient with CGD and Hodgkin's disease

prevalence and clinical significance of anticardiolipin antibody in acute myeloblastic leukemia

Antiphospholipid antibodies, including lupus anticoagulants and anticardiolipin [aCL] antibodies are associated with a wide variety of disorders including malignancies. The aim of this study was to investigate the prevalence and prognostic significance of aCL antibodies in Iranian patients with acute myeloblastic leukemia [AML]. Forty-one patients with AML [27 men and 14 women, mean age 34.9 +/- 16.7 years] were included in this study. aCL IgG and aCL IgM antibodies were evaluated in patients before induction chemotherapy. All patients were followed up for chemotherapy response. Antibodies [IgG, IgM or both] were found in 26 of 41 patients [63.4%], of whom 19 [46.3%] had a low titer, 6 [14.6%] a moderate titer and 1 [2.4%] a high antibody titer. No correlation was found between complete remission or relapse and aCL antibodies positivity. aCL antibody titers are slightly to moderately elevated in patients with hematologic malignancies, and these antibodies do not correlate with disease prognosis

role of clinical, therapeutic and laboratory findings in monitoring of HCMV infection in bone marrow transplant recipients

Human cytomegalovirus [HCMV] has been an enormous threat for bone marrow transplant [BMT] recipients. For active and/or latent HCMV infection, diagnosis of the risk factors which increase the risk of posttransplant morbidity and mortality seems necessary. In this research, some of the HCMV risk factors were monitored and compared with HCMV molecular diagnostic methods for better detection of HCMV infection in BMT patients. HCMV risk factors including clinical, biological, biochemical, haematological indexes, and also anti-HCMV and transplant prophylactic and therapeutic conditioning regimens were monitored from March 2002 to March 2006, in 104 BMT patients referred to BMT Unit of Nemazee Hospital in Shiraz University of Medical Sciences and was compared with HCMV molecular methods for BMT donors and recipients' pre- and posttransplantation. Anti-HCMV-lgM was detected in 9.6% and 6.7% of BMT recipients and donors, respectively. Anti-HCMV-lgG was also detected in 8.7% and 9.1% of recipients and donors, pre-transplant, respectively. HCMVPCR results were positive in 20% of recipients and 33.3% of donors. Significant correlations were observed between HCMV positive results and the use of a therapeutic dose, but not the prophylactic dose of glucocorticoids and cyclosporine, pre and post-transplantation. Fasting blood sugar, creatinine, globulin, and liver enzymes levels such as alkaline phosphates and asparagine transpherase significantly correlated with detection of HCMVDNA in transplant patients. Also, negative results of HCMV-PCR significantly correlated with the use of prophylactic dose of acyclovir in BMT patients. Significant correlations of positive and negative HCMV-PCR results with HCMV disease risk factors suggest the possible role of these factors on prognosis and monitoring of HCMV disease in BMT recipients preand post-transplantation

[Evaluation of discrimination indices validity for screening of betas-thalassemia trait]

Beta-thalassemia trait [beta-TT] and iron deficiency anemia [IDA] are the most common forms of microcytic anemia. Screening of beta-thalassemia trait is important for medical counseling before marriage and preventing beta-thalassemia major birth results. The most common problem in screening beta-TT is differentiating it from IDA. The aim of this study was to define the sensitivity, specificity, and predictive values of some discrimination indices for screening of beta-TT in a sample of such patients. A total of 82 patients with microcytic anemia [MCV< 80 fl] were selected from Namazi Hospital, Shiraz, Iran, and 9 discrimination indices were calculated for them. The patients were divided intotwo groups: 42 patients with beta-TT and 40 patients with IDA. The sensitivity, specificity, positive and negative predictive values and Youden,s index of each discrimination index were calculated for screening beta-TT. None of the discrimination indices showed 100% of sensitivity and specificity. But the Shin and Lal index, RDW index and RBC count showed the highest and valuable value for screening beta-TT. Some discrimination indices like Shin and Lal index, RDW index and RBC index are valuable indices in screening beta-TT

Hematopoietic stem cell transplantation in southern Iran: history, current status and future direction

Transplantation of hematopoietic stem cells [HSCT] has become the standards treatment for many patients with congenital or acquired disorders of the hematopoietic system or with chemo-radio or immuno-sensitive malignancies. HSCT has undergone rapid expansion over the past two decades. Despite the high cost and the complexity of the procedure, HSCT has developed in developing countries. The transplant program was established in Shiraz University of Medical Sciences in 1993 in Shiraz, southern Iran and is a referral center for about 10 million patients with hematology-oncology diseases. From 1993 to 2009, more than 450 allogeneic and autologous transplantations were undertaken. Since 2003, stem cell sources from the bone marrow have changed to peripheral blood for almost all disease indications. The main indication for HSCT is now the hematologic malignancies instead of hemoglobinopathy [thalassemia major]. From 1993 to 2007, HSCT was performed on 155 blood transfusion dependent patients with thalassemia major with disease-free survival and overall survival of 71% and 77%, respectively. During this time, 127 leukemia patients underwent allogeneic HSCT including AML [n=68], ALL [n=30] and CML [n=29]. In this group, long term disease-free survival rate [cure rate] was 67%, 60% and 62%, respectively. Even HSCT is rising rapidly in during the five past years; however, when the total transplantation to the total number of population is compared in our region, the rate is still low. It seems that the government should support the therapeutic approaches more in our country and help to overcome the difficulties

efficacy of transcutaneous electrical nerve stimulation in control of nausea and vomiting in patients undergoing chemotherapy

Despite advances in antiemetic treatment, complications are still problematic for a significant number of patients after chemotherapy. This study was performed to determine the efficacy of transcutaneous electrical nerve stimulation [TENS] in the control of nausea and vomiting in patients undergoing chemotherapy at Nemazee Hospital in Shiraz, southern Iran.32 subjects with cancer from Outpatients Depatment in Nemazee Hospital affiliated to Shiraz University of Medical Sciences, in Shiraz, southern Iran were enrolled. The patients were randomly divided into two equal groups of TENS and placebo. Patients in both groups were matched for age, severity of nausea and vomiting and type of malignancy. Cisplatin or cyclophosphamide was used for chemotherapy and granistron along with dexametasone were used as antiemetic agents. In the test group, the p6 acupuncture point [acupoint] was stimulated by TENS when the antiemetic agent was administered and continued during wakening every 2 hours for 72 hours after chemotherapy. The placebo group was similarly treated but with an off mode stimulator. In regard to the severity of nausea, no statistically significant difference was observed between the two groups in the first 24 hours of chemotherapy but the intensity of nausea in the TENS group was significantly lower than those of the placebo group during 48 and 72 hours of chemotherapy. The mean frequency of vomiting during first, second and third 24 hours was significantly lower in the control group. TENS can be used as an adjunct with antiemetics for controlling nausea and vomiting induced by chemotherapy

Bone marrow transplantation in thalassaemia patients in Shiraz, Islamic Republic of Iran

We report the results of allogeneic bone marrow transplantation in 26 female and 37 male patients with beta-thalassaemia major [age range: 2-17 years], performed at Namazi Hospital over the period 1992-99. In all cases, standard conditioning and immunosuppressive regimens were employed. Currently, 50 patients remain thalassaemia-free, 9 of whom have developed chronic graft-versus-host disease. There were 8 deaths among the 13 unsuccessful transplant cases: 4 due to acute uncontrollable graft-versus-host disease, and 4 to non-transplant-related causes such as hypoglycaemia, hypersensitivity reactions and advanced disease. We conclude that allogeneic bone marrow transplantation is an effective therapy for the treatment of beta-thalassaemia major, particularly for patients classified as classes I and II

Acute graft-versus-host disease in thalassaemic marrow transplantation with low-dose antithymocyte globulin

Our unit performed transplantations on 21 classes II and III thalassaemic patients [class II patients had either hepatomegaly or portal fibrosis and class III patients had both]. We used busulfan [15 mg/kg] and cyclophosphamide [200 mg/kg]. Graft-versus-host disease [GVHD] prophylaxis was cyclosporin, prednisolone and low-dose antithymocyte globulin. Our patient data showed a low incidence of acute GVHD following transplantation. We offer this regimen as an acceptable therapy for thalassaemic patients undergoing allogeneic marrow transplantation as a safe clinical procedure, irrespective of the class of patient