The outcome of chemotherapeutic regimen by high-risk pre-B-cell protocol in ALL children.

OBJECTIVE: The aim of this study was to investigate the outcome of chemotherapeutic regimen by high-risk pre-B-cell potocol in ALL children. METHODS: The cross-sectional study was conducted on 55 children who were treated with the Children Oncology Group (COG) protocol from September 2010 to February 2015 to evaluate the chemotherapeutic regimen results. RESULTS: There was a complete recovery rate of 76.4% during the first week after treatment. Three-year overall survival was 85.5% and five-year overall survival was 81%. Relapse rate after first remission was 20% and death after relapse was 50%. Thirty percent of total deaths were at the induction period. All of the deceased cases died due to sepsis. CONCLUSION: Results showed that the survival rate increased. By choosing the COG protocol and by controlling infection in patients without considering the risk group we can improve survival rates.

Réponse à un schéma chimiothérapeutique administré à des enfants atteints de LAL à cellules pré-B à risque élevé selon le protocole COG.

OBJECTIF: La présente étude a pour but d'examiner la réponse à un schéma chimiothérapeutique administré à des enfants atteints de LAL à cellules pré-B à risque élevé selon le protocole COG. MÉTHODE: L'étude transversale porte sur 55 enfants traités selon le protocole du groupe d'oncologie pédiatrique (mieux connu sous le nom de Children's Oncology Group ou COG), de septembre 2010 à février 2015, et évalue les résultats du schéma chimiothérapeutique. RÉSULTATS: Durant la première semaine suivant le traitement, le taux de rétablissement complet a été de 76,4 %. Les taux de survie après trois ans et cinq ans étaient respectivement de 85,5 % et de 81 %. Le taux de rechute après le premier épisode de rémission a été de 20 % et le taux de mortalité consécutif à cette rechute a été de 50 %. Trente pour cent de l'ensemble des décès ont eu lieu durant la période d'induction. Dans tous les cas, une septicémie en est la cause. CONCLUSION: Les résultats indiquent que le taux de survie a augmenté. Il est donc possible d'améliorer le taux de survie en optant pour le protocole COG et en contrôlant les infections chez les patients, et ce, sans égard au groupe de risque.

Fabrication of chitosan-polyvinyl alcohol and silk electrospun fiber seeded with differentiated keratinocyte for skin tissue regeneration in animal wound model.

Hybrid fibrous mat containing cell interactive molecules offers the ability to deliver the cells and drugs in wound bed, which will help to achieve a high therapeutic treatment. In this study, a co-electrospun hybrid of polyvinyl alcohol (PVA), chitosan (Ch) and silk fibrous mat was developed and their wound healing potential by localizing bone marrow mesenchymal stem cells (MSCs)-derived keratinocytes on it was evaluated in vitro and in vivo. It was expected that fabricated hybrid construct could promote wound healing due to its structure, physical, biological specifications. The fabricated fibrous mats were characterized for their structural, mechanical and biochemical properties. The shape uniformity and pore size of fibers showed smooth and homogenous structures of them. Fourier transform infrared spectroscopy (FTIR) verified all typical absorption characteristics of Ch-PVA + Silk polymers as well as Ch-PVA or pure PVA substrates. The contact angle and wettability measurement of fibers showed that mats found moderate hydrophilicity by addition of Ch and silk substrates compared with PVA alone. The mechanical features of Ch-PVA + Silk fibrous mat increase significantly through co-electrospun process as well as hybridization of these synthetic and natural polymers. Higher degrees of cellular attachment and proliferation obtained on Ch-PVA + Silk fibers compared with PVA and Ch-PVA fibers. In terms of the capability of Ch-PVA + Silk fibers and MSC-derived keratinocytes, histological analysis and skin regeneration results showed this novel fibrous construct could be suggested as a skin substitute in the repair of injured skin and regenerative medicine applications.

Location of the Cut Flexor Tendons in the Palm Using Surface Anatomy: A Simple Guide for Minimal Incision Surgery.

BACKGROUND: Hand Zone 2 flexor injuries are among the most important tendon lesions and its prognosis is poorer than the other hand zones. Limited incisions prevent multiple skin flaps. The present study aimed to determine the location of palmar flexor tendons using surface anatomical markers to provide a simple and easy guide for hand surgeons assisting them in minimal incisions. METHODS: Patients with hand injuries in Zone 2 were taken to the operating room for surgery. The skin and subcutaneous tissue over the flexor tendons sheath were incised. After finding the flexor tendons in the palm, their exact position was located with a blue needle (23G) over the palm crease and marked relative to the finger borders. RESULTS: Thirty-eight patients with the mean age of 27±3.6 years were operated. Totally, 57 fingers and 38 palms were dissected. The flexor tendons were located under the proximal and distal palm creases between two parallel lines extended from finger borders and mid-axial axis of the fingers. The average distance from finger print to distal palmar crease was 25, 32 and 24 mm for little, ring and long finger, respectively and 32 mm from index finger print to mid palmar crease. CONCLUSION: The precise position of flexor tendons can be easily determined in the palm according to surface anatomical markers and plan for limited incisions.

The Incidence of Minor ß-thalassemia Among Individuals Participated in Premarital Screening Program in Ardabil Province: North-west of Iran.

INTRODUCTION: The most effective way to prevent thalassemia is to screen for the disease at the population level and then to evaluate the molecularity of individuals. Considering the importance of minor ß-thalassemia and its high prevalence in societies. AIM: to investigate the incidence of minor ß-thalassemia among Individuals participated in Premarital Screening Program in Ardabil province: North-west of Iran. METHODS: This descriptive cross-sectional study was conducted on 39620 individuals participated in the national screening program for Minor ß-Thalassemia. Of them 1925 cases had mean corpuscular volume (MCV) < 80 in one person or couple which referred to HbA2 concentration check. RESULTS: Of all 1925 cases, 95 cases (4.93%) had HbA2>3.5 and defined as Minor ß-Thalassemia. The total incidence of minor ß-thalassemia among all participated people was 2.4%. Of thalassemia cases 48.4% were women and 51.6% were men. Of all ß-thalassemia cases, 49.5% live in Ardabil city and rest of them live in other cities. CONCLUSION: Results showed that the prevalence of minor ß-thalassemia in Ardabil province was lower than country average rate and a study should be done in future for exact estimation of the disease.

Reconstruction following Excision of Malignant Scalp Tumors with Split Thickness Skin Graft with and without Acellular Dermal Matrix: A Comparative Study.

BACKGROUND: Basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are the most common malignancies, which occur on the scalp. There are various therapeutic methods for managing these malignancies in which the standard treatment method of both is surgical excision with a good margin. Sometimes, the patients need full-thickness excision due to the deep invasion, so exposing the underlying calvarium may be a challenge for surgeons. OBJECTIVES: We evaluated the outcomes of using the combined therapy of acellular dermal matrix and split-thickness skin graft (STSG) in comparison with using only STSG in the treatment of defects caused by the excision of scalp malignant tumors among the patients who attended Imam Khomeini Hospital Complex and Razi Hospital of Tehran, Iran. We also evaluated the satisfaction of both surgeons and patients among these two methods of treatment. MATERIALS AND METHODS: All the candidates were divided into the two groups, that is, of case and control, randomly. The case group underwent the treatment using acellular dermal matrix and STSG, whereas the control group underwent the treatment by only STSG on the wound. In both groups, BCC and SCC were excised with a margin of 6 and 10 mm, respectively, on the skull bone. Then, a layer of bone was removed by osteotomy in order to reach the bleeding points. All patients were followed up for 7, 30, and 90 days after the surgery, and the results were recorded. RESULTS: A significant difference in Manchester Scar Scale, wound contour formation, the mobility of the repair site, and patients and surgeon satisfaction was observed among both groups based on visual analog scale. We found better outcomes in the case group, especially in wound contour formation during 90 days of follow-up. However, the satisfaction of both surgeons and patients was achieved in the case group. Satisfaction of surgeons was achieved in the case group with a relative superiority to the control group according to the Manchester Scar Scale.

Service quality in Iranian hospitals: A systematic review and meta-analysis.

Background: This study aimed to explore service quality in Iranian hospitals by a systematic review and meta-analysis of the existing literature. Methods: The literature search in the international (PubMed, Scopus, and the ISI) and Iranian (SID, Iranmedex, and Magiran) scientific databases was conducted to identify studies (published in English and Persian) used the service quality gap (SERVQUAL) model to examine service quality in Iranian hospitals between 2000 and 2016. The databases were searched using a combination of the following keywords: "hospital service quality", or "healthcare service quality", and "SERVQUAL model", or "gap model", and "Iran". A random-effects meta-analysis model was used to investigate the quality of hospital care in Iran. Results: A total of 13 articles with 4,217 patients were included in the study. Results indicate that there are negative gap values between patients' expectations and perceptions in six SERVQUAL dimensions namely. tangibility, reliability, responsiveness, assurance, empathy, and access. The overall mean score of patients' expectations and perceptions of quality of hospital care in Iran were estimated 4.59 and 3.69, respectively (i.e., quality score gap= -0.9). The highest and lowest quality score gap values were related to the reliability and responsiveness dimensions, correspondingly. Conclusion: The study found that expectations of patients from hospital care have not been met in Iran. Thus, improving service quality in Iranian hospitals warrants further attention by health professionals, health policy-makers, and hospital managers.

Medication errors among nurses in teaching hospitals in the west of Iran: what we need to know about prevalence, types, and barriers to reporting.

OBJECTIVES: This study aimed to examine the prevalence and types of medication errors (MEs), as well as barriers to reporting MEs, among nurses working in 7 teaching hospitals affiliated with Kermanshah University of Medical Sciences in 2016. METHODS: A convenience sampling method was used to select the study participants (n=500 nurses). A self-constructed questionnaire was employed to collect information on participants' socio-demographic characteristics (10 items), their perceptions about the main causes of MEs (31 items), and barriers to reporting MEs to nurse managers (11 items). Data were collected from September 1 to November 30, 2016. Negative binomial regression was used to identify the main predictors of the frequency of MEs among nurses. RESULTS: The prevalence of MEs was 17.0% (95% confidence interval, 13.7 to 20.3%). The most common types of MEs were administering medications at the wrong time (24.0%), dosage errors (16.8%), and administering medications to the wrong patient (13.8%). A heavy workload and the type of shift work were considered to be the main causes of MEs by nursing staff. Our findings showed that 45.0% of nurses did not report MEs. A heavy workload due to a high number of patients was the most important reason for not reporting MEs (mean score, 3.57±1.03) among nurses. Being male, having a second unrelated job, and fixed shift work significantly increased MEs among nurses (p=0.001). CONCLUSIONS: Our study documented a high prevalence of MEs among nurses in the west of Iran. A heavy workload was considered to be the most important barrier to reporting MEs among nurses. Thus, appropriate strategies (e.g., reducing the nursing staff workload) should be developed to address MEs and improve patient safety in hospital settings in Iran.

Period Prevalence and Reporting Rate of Needlestick Injuries to Nurses in Iran: A Systematic Review and Meta-Analysis.

The purpose of this systematic review and meta-analysis was to provide a precise estimate of the period prevalence of needlestick injuries (NSI) among nurses working in hospitals in Iran and the reporting rate of NSI to nurse managers. We searched both international (PubMed, Scopus and the Institute for Scientific Information) and Iranian (Scientific Information Database, Iranmedex and Magiran) scientific databases to find studies published from 2000 to 2016 of NSI among Iranian nurses. The following keywords in Persian and English were used: "needle-stick" or "needle stick" or "needlestick," with and without "injury" or "injuries," "prevalence" or "frequency," "nurses" or "nursing staff," and "Iran." In a sample of 21 articles with 6,480 participants, we estimated that the overall 1-year period prevalence of NSI was 44% (95% confidence interval [CI], 35-53%) among Iranian nurses. The overall 1-year period prevalence of reporting NSI to nurse managers was 42% (95% CI, 33-52%). In meta-regression analysis, sample size, mean age, years of experience, and gender ratio were not associated with prevalence of NSI or reporting rate. The year of data collection was positively associated with period prevalence of NSI (p < .05), but not with the period prevalence of reporting NSI to nurse managers. Results indicated a high NSI period prevalence and low NSI reporting rate among nurses in Iran. Thus, effective interventions are required in hospitals in Iran to reduce the prevalence and increase the reporting rate of NSI. © 2017 Wiley Periodicals, Inc.

Study Frequency of Hypertension and Obesity and their Relationship with Lifestyle Factors (Nutritional Habits, Physical Activity, Cigarette Consumption) in Ardabil City Physicians, 2012-13.

BACKGROUND AND OBJECTIVE: Few studies have been done on lifestyle of Iranian physicians. As physicians have important role in health promotion, the main goal of the study was to assess the lifestyle of this influential group. MATERIALS AND METHODS: A cross-sectional descriptive study was conducted on lifestyle of all registered physicians of Ardabil hospitals, Iran, 2012-13. In this research, 225 physicians were selected, by using simple random sampling. Demographic and lifestyle data were obtained by self-report using standard questionnaires, physical activity by official Iranian short-version of the international physical activity questionnaire, and dietary intake by food frequency questionnaire. Weight and height was performed according to standard protocols by using standardized and zero calibrated instruments. Data were analyzed by inferential statistics using Statistical Package for the Social Sciences. 16 software. RESULTS: Findings showed that 8% of participants were hypertensive, 21.3% smoker, 40%-47% inactive, 51.1% overweight, and 18.2% obese. There was a significant relationship between blood pressure and self-reported lifestyle habits (P < 0.05). And 70.7% of males and 74.1% of females had regular 10-min walking each day and moderate activity of males was significantly higher than females (P < 0.05). Food frequency weekly consumption of overweight and obese physicians were significantly higher than normal weight physicians (P < 0.05). CONCLUSION: Few doctors follow a healthy lifestyle; this may have a negative effect on society attitude about health.

A Rare Presentation of Primary Nasopharyngeal Carcinoma (NPC) in Mediastinum.

INTRODUCTION: Nasopharyngeal carcinoma among the children has been rare accounting for only 1% of all pediatric malignancies. Both genetic and environmental factors have contributed to the development of nasopharyngeal carcinoma. Among the children there was a higher rate of undifferentiated histology. The mean age of nasopharyngeal carcinoma diagnosis has been 11 years old age; and the most common site was nasopharynx. Palpable lymphadenopathy, dysphasia and neural defect were common associated signs. CASE PRESENTATION: A 15-year-old boy has presented with a mass that located near by the heart in the left side of mediastinum with invasion to anterior mediastinum from two years ago. In biopsy, nasopharyngeal carcinoma, non-keratinizing type, has diagnosed while there was no involvement of nasopharyngeal region. Patient has treated by 70 Gy (2.0 Gy/fraction) radiotherapy plus concomitant chemotherapy with base of docetaxel. But the mass had no regression. Then, the patient has treated with Cisplatin 100 mg/m2 IV on days 1, 22, and 43 with radiation, then cisplatin 80 mg/m2 IV on day 1 plus fluorouracil (5-FU) 1000 mg/m2/day by continuous IV infusion on days 1 - 4 every 4wk for 3 cycles and after remission interferon beta has added to treatment for 6 months duration as a maintenance therapy. After 1 year follow up; the patient was in complete remission. In the course of therapy, only hypothyroidism has occurred. CONCLUSIONS: Nasopharyngeal carcinoma in childhood, without nasopharyngeal involvement, initially could be detected in other sites such as pericardium. Also good results could be respected by cisplatin and 5-fluorouracil based neoadjuvant chemotherapy before radiotherapy plus interferon beta as a maintenance therapy in childhood aggressive nasopharyngeal carcinoma.

Patient with FMF and Triple MEFV Gene Mutations.

INTRODUCTION: Familial Mediterranean fever (FMF) is the most common auto-inflammatory disease with monogenic (MEditerranean FeVer -MEFV- gene) inherited pattern. It mainly affects ethnic groups living along the eastern Mediterranean Sea: Turks, Sephardic Jews, Armenians, and Arabs [1]. Today FMF is not rare disease in other Mediterranean ethnicities, such as Greeks, Italians, and Iranians. CASE REPORT: Here we report a child with complex allele mutations E148Q/V726A/R761H, whilst, whose mother showed E148Q/V726A and his father had R761H/wt in analysis. The severity of the disease and genotype-phenotype correlation of patient showed no significant differences with his mother and other patients with the same two mutations, V726A/R761H, E148Q/V726A, and E148Q/R761H. CONCLUSION: This type of mutation is the first report of triple mutations in FMF patients with no specific phenotype correlation.

Epidemiology of Childhood Cancer in Northwest Iran.

This case series study was performed for all 83 children below 14 years old suffering from cancer during 2010-2013 who were registered in Ardabil pediatric cancer registry (APCR). The required data were collected by questionnaire and analyzed with SPSS.19 statistical methods software. Some 51 (61.4%) of cases were male. The mean age of patients was 5.8 years. Of the total, 60 (72.3%) of cases were from urban areas. Results showed that leukemia with 54.2%, CNS with 12% and neuroblastoma with 8.4% were the most prevalent childhood malignancies in Ardabil province. Based on the under 14 year old population estimated from Ardabil province, the cumulative incidence rate was 95.4 patients per one million. The incidence rate was relatively high so that childhood cancers should be considered as an important issue in health policy making in Ardabil province of Iran.

Surgical management of ERCP-related complications.

AIM: The aim of this study was to analyze clinical findings and treatment outcomes of patients with endoscopic retrograde cholangiopancreatography complications. BACKGROUND: Endoscopic retrograde cholangiopancreatography has become a very common procedure for the evaluation and treatment of biliary and pancreatic diseases. PATIENTS AND METHODS: A retrospective review of 2447 endoscopic retrograde cholangiopancreatography procedures and their complications since Apr 2006 till Dec 2010 was conducted to identify their incidence, optimal management, and clinical outcomes. RESULTS: 2447 endoscopic retrograde cholangiopancreatography procedures were performed. Overall, complications developed in 168 (6.9%) cases: perforation in 10 (0.4%), hemorrhage in 4 (0.16%) and mild to severe pancreatitis in 154 (6.3%). The patients mean age was 66± 6 yrs with females/ males of 1432(58.5%)/ 1015(41.5%). Abdominal pain, nausea, leukocytosis and hyperamylasemia were most common findings in these patients. Surgery was performed for 6 patients (0.24%). The most hospital station was 20 days: surgical group 7±2 days, pancreatitis 11± 4 days and average 6 days for others. CONCLUSION: Endoscopic retrograde cholangiopancreatography remains the endoscopic procedure that carries a high risk for morbidity and or mortality. The majority of events are of mild-to-moderate severity and when surgery should be done, it depends upon the clinicopathological condition and we don't advise pyloric exclusion, gastrojejunostomy and duodenal diversion for these patients.