Tehran University Medical Journal

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Background: Hematopoietic stem cell (HSC) transplantation has brought the possibility of the use of high dose chemotherapy in the treatment of malignant hematopoietic diseases. Short-term HSC preservation at 4˚C is the most common method for autologous peripheral blood stem cell transplantation (PBSCT).

Materials and Methods: Thirty-seven mobilized PBSC samples from thirteen hematological patients (4 AML, 4 MM and 5 Lymphoma cases) who were selected for autologous PBSCT and 24 normal candidates for allogenic PBSCT were preserved in five separate sterile 2 ml tubes in 4˚C. Each sample was evaluated for total nucleated cell (TNC) count, dye exclusion cell viability and Granulocyte-Macrophage colony forming unit (GM-CFU in semisolid medium after 16 days) in days 0, 2, 4, 6 and 8. The results were converted to percentages of day 0 measures. The data were analyzed by SPSS 10.0 using Paired Samples T test, Independent Samples T test and Regression.

Results: The mean percentages (and standard deviations) of TNC count, cell viability and GM-CFU for days 0, 2, 4, 6 and 8 are shown below: No significant correlation was found between age, sex, weight and the kind of donor with TNC, viability and GM-CFU.

Conclusion: In this study, we have found that during storage of mobilized PBSC in 4˚C, TNC count and cell viability still remains higher than 70% after eight days, while GM-CFU decreases more rapidly and falls to less than 50% after day 4.Therefore, TNC count and cell viability do not decrease as fast as GM-CFU.

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Background: Thrombocytopenia is a common finding in individuals infected with HIV and its incidence increases with progressive immunosuppression. Thrombocytopenia due to AIDS is divided into primary and secondary forms and primary HIV associated thrombocytopenia (PHAT) is the most common cause of thrombocytopenia in these patients.

Case presentation: The patient was a 35-year old man with HIV since 1996, who was admitted to Imam Khomeini hospital in August of 2010 with petechiae, purpura, ecchymosis around the eyes and on the limbs and subconjunctival hemorrhage. In laboratory investigation, platelet count was 5000/µL. After ruling out the secondary causes of thrombocytopenia, Primary HIV Associated Thrombocytopenia (PHAT) was diagnosed. Due to the presence of severe thrombocytopenia and bleeding symptoms and considering the fact that antiretroviral agents require 4- 6 weeks to reach therapeutic effects, prednisone and antiretrovirals (AZT) were prescribed. After about two weeks of steroids administration, platelet count reached 50,000/µL and about eight weeks after antiretroviral (AZT) therapy platelets reached nearly 140,000/µL.

Conclusion: Prednisone can be used safely in conjunction with antiretrovirals for primary thrombocytopenia in HIV infected patients with severe thrombocytopenia and bleeding symptoms.

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Background: HIV infection reduces the immune system and is the most significant factor in the spread of TB in recent years and one of the causes of death in HIV -seropositive patients. TB is the most commonly diagnosed opportunistic infection and the most frequent direct cause of death among HIV infected patients. The HIV infection can accelerate progression of TB infection to active TB disease. Among patients with active TB, those with HIV co-infection have the greatest risk for relapse. Regardless of increasing rate of TB and HIV in Iran, we decided to s urvey outcome of TB in HIV positive patients who treated with standard regimens in the years 2003-2012.

Methods: This retrospective cohort study was conducted on HIV-positive patients with TB referred to Behavioral Diseases Consultation Center and Infectious Diseases Ward of Imam Khomeini Hospital from 2003 to 2012. Outcome was defined as failure, relapse and mortality. Moreover, the relationship between outcomes and number of CD4, co-trimoxazole and antiretroviral intake, type of TB and AIDS defining illness was studied. Results: This study had 135 patients, 8 (5.9%) were females and 127 (94.1%) were males. The mean age of the patients was 40.14+10.02 and the most way to catch HIV in this study was intravenous drug user. There were 3 (2.22%) cases of failure, 15 ( 11.1%) relapse , and 21 ( 15.8%) deaths. Antiretroviral therapy, AIDS defining illness, type of TB and co-trimoxazole intake did not soley affect relapse. CD4 level was the most effective variables in relapse [ Hazard ratio: 0.392 (0.11-1.4) Relative Risk: 0.809 (0.593-1.103) (P=0.068) ]. However, regard to CI95%, the impact of CD4 on relapse is not significant and antiretroviral intake was the most important and effective variable in increasing their survival. Hazard ratio: 0.137 (0.141-0.45) Relative Risk: 0.686 (0.513-0.918) (P=0.001) Conclusion: Overall, receiving antiretroviral was the most important factor influencing the outcome of patients.

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Background: There is no need to explain the importance of collection, recording and analyzing the information of disease in any health organization. In this regard, systematic design of standard data sets can be helpful to record uniform and consistent information. It can create interoperability between health care systems. The main purpose of this study was design the core dataset to record colorectal cancer information in Iran.

Methods: For the design of the colorectal cancer core data set, a combination of literature review and expert consensus were used. In the first phase, the draft of the data set was designed based on colorectal cancer literature review and comparative studies. Then, in the second phase, this data set was evaluated by experts from different discipline such as medical informatics, oncology and surgery. Their comments and opinion were taken. In the third phase refined data set, was evaluated again by experts and eventually data set was proposed. Results: In first phase, based on the literature review, a draft set of 85 data elements was designed. In the second phase this data set was evaluated by experts and supplementary information was offered by professionals in subgroups especially in treatment part. In this phase the number of elements totally were arrived to 93 numbers. In the third phase, evaluation was conducted by experts and finally this dataset was designed in five main parts including: demographic information, diagnostic information, treatment information, clinical status assessment information, and clinical trial information. Conclusion: In this study the comprehensive core data set of colorectal cancer was designed. This dataset in the field of collecting colorectal cancer information can be useful through facilitating exchange of health information. Designing such data set for similar disease can help providers to collect standard data from patients and can accelerate retrieval from storage systems.

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Background: Diabetic foot infection is the most common complication of diabetic foot ulcer (DFU) leading to amputation. The treatment requires special attention to disease conditions, proper diagnosis, appropriate sampling for cultures, careful selection of antibiotics, rapid determination of the patient’s need for surgical intervention, and wound care. Clearly a systematic approach or, if possible, an evidence-based approach by using clinical guidelines about diabetic foot infections will lead to better outcomes. In this regard, this article aims to adopt the IWGDF clinical practice guideline on DFU infection.
Methods: In this study, the adoption of the international evidence-based clinical guidelines on the DFU infection was carried out using the ADAPTE methodology, which involved three stages of setup, adoption, and finalization. AGREE II tool was used to evaluate the quality of the selected clinical guideline.

Results: The results of this adopted clinical guideline according to the national facilities and access to equipment are described with 26 recommendations along with related reasons for the diagnosis and treatment of diabetic foot ulcer infections. The recommendation categorized into six different categories including Classification/ Diagnosis, Osteomyelitis, Assessing severity, Microbiological considerations, Surgical treatment, Antimicrobial therapy. Conclusion: The mentioned recommendations in the diagnosis and treatment of diabetic foot ulcer infections extracted based on the methodology of systematic review studies. Actually the opinion of experts have been prepared and adjusted according to the limitations, equipment and facilities in the country. But in general, there are some challenges in diabetic foot infections should be considered as well. So monitoring the treatment of infection, optimal duration of antibiotic treatment, optimal treatment of infection in low-income countries, time and type of imaging studies, selection of medical or surgical treatments and hospitalization conditions are some of these challenges. However the definition and practical clinical application for the concept of bacterial bioburden of the wound for wound healing, evaluating the cost-effectiveness of new technologies in improving treatment and appropriate interpretation of microbiological (genotypic) microbiological tests are important too.