Tehran University Medical Journal

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Background: Bone marrow transplantation (BMT) is the treatment of choice for many patients with malignant and nonmalignant diseases. Long-term complications such as osteoporosis should be considered, because it is directly associated with the morbidity and mortality. The purpose of this study is to assess the bone mineral density after allogenic or autologous bone marrow transplantation in patients with leukemia or lymphoma.
Methods: We prospectively investigated 63 patients undergoing BMT for acute and chronic leukemia and lymphoma. At the end of the study, a total of 28 patients were assessed. Bone mineral density (BMD) was measured prior BMT, and 6 and 12 months after BMT. Osteocalcin, bone alkaline phosphatase and C-terminal telopeptides of type 1 collagen (ICTP) were assessed. Serum concentration of calcium, phosphorous, vitamin D, PTH and sex hormones (FSH, LH, testosterone and estradiol) were also measured.
Results: There was a significant decrease in the bone mineral density of the femoral neck six months after BMT (p<0.001), 1.01±0.13g/cm² prior to BMT and 0.96±0.13 g/cm² at six months, but no considerable changes were seen in lumbar vertebrae. Bone loss between the 6th and 12th months was not observed. The levels of ICTP and phosphorus increased significantly by the 12th month (p=0.04). The level of calcium was higher at the 6th month (p=0.002) but the level of vitamin D and PTH decreased by the end of the study (p=0.04 and p=0.01, respectively) and the average of osteocalcin did not increase significantly. In women, the level of estradiol decreased by the 6th month (p=0.01), but the testosterone changes were not significant.
Conclusion: The risk of bone loss in both allogeneic and autologous BMT is higher in the femoral neck than the lumbar vertebrae, occurring mainly in the first six months after BMT. Preventive and clinical procedures should be considered.

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Background: Sleep has a major role in daily cycles and reconstruction of physical and mental abilities. Regarding the importance of this feature, we decided to determine sleep quality in medical students.

Methods: A questionnaire containing demographic data, Epworth Sleepiness Scale and Pittsburgh Sleep Quality Index was prepared. We distributed the questionnaires using a census method to every student at the Zanjan Faculty of Medicine. The completed questionnaires were collected and the data was analyzed using SPSS.

Results: A total of 224 students answered the questionnaire, with 133 (59.4%) students evaluated to have good sleep quality and 91 (40.6%) poor sleep quality. Of these 91 students, 38% were female and 44.8% were male (p=0.307). The prevalence of poor sleep quality according to the four stages of medical training was 24.6% of those in basic sciences, 42.9% of those in physiopathology, 41.7% of externs, and 53.5% of interns (p=0.008). According to residential status, the prevalence of poor sleep quality was 61.5% among students living with their spouse, 44.6% for students living in their own private homes, 37.6% among students living in the dormitory, and 20.8% for those living with their parents (p=0.024). According to marital status, 35.8% of singles and 64.9% of married students had poor sleep quality (p=0.001). According to financial status, 57.9%, 46.9%, and 33.9% of those from low, moderate and high economic classes, respectively, were sleep deprived (p=0.049). Among those with average grades of under 16 and over 16 out of 20, 47.5% and 32%, respectively, were suffering from poor sleep quality (p=0.047). There was no obvious relationship between sleep quality and BMI, sex, or history of depression or anxiety.

Conclusion: Poor sleep quality was significantly associated with lower grades, economic status, living arrangement and type of training. A large number of students quality of life and work may suffer because sleep deprivation.

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Background: One of the most important components of coronary artery bypass graft surgery is need for blood transfusion that increases morbidity and mortality. The aim of this study was to evaluate the factors affecting the need for blood transfusion during off pump coronary artery bypass (OPCAB) surgery.
Methods: In this descriptive case control study 923 patients who had undergone OPCAB at Afshar Hospital in Yazd, Iran, from July 2008 to January 2010 were evaluated. The data was gathered from their records and was analyzed.
Results: 54% of male and 79% of female patient need blood transfusion. Mean age in patients needed transfusion was 61.58±11.11 years and in other group was 60.27±10.98 years of the patients that needed transfusion (p= 0.08). 563 (61%) of the patients needed transfusion with the average of two units. The need for blood transfusion was higher in female gender (p< 0.0001), low hematocrit (p< 0.0001), diabetes (p< 0.001), hypertension (p< 0.025) and multiple grafts (p< 0.027). There were no significant differences in preoperative hemostasis tests, affection to hyperlipidemia, CVA or renal failure, antiplatelet drug administration and the application of left internal mammary artery between the transfusion and non transfusion groups.
Conclusion: In this study preoperative hematocrit was most important risk factor in transfusion in patients that underwent OPCAB. Female gender, preoperative low hematocrit, multiple grafts, diabetes and hypertension increased the rate of blood transfusion. According to the high prevalence of blood transfusion in OPCAB, considering factors that affect the transfusion rate is essential.

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Background: Many chemotherapeutic regimens used in the treatment of cancer generate free radicals that may be a part of their beneficial effects. The aim of this study was to assess the oxidative status in patients undergoing chemotherapy for acute myeloid leukemia (AML).

Methods: Thirty-eight patients with AML (17 female and 21 male patients) with a mean age 34.05±12.49 years were included in the study. All the patients received cytarabine and daunorubicin as their standard induction therapy. Serum levels of malondialdehyde (MDA), total antioxidant capacity (TAC), and also the erythrocyte superoxide dismutase and glutathione peroxidase activities were measured before and 14 days after chemotherapy.

Results: Plasma malondialdehyde concentrations increased significantly (from a former 2.68±0.89 nmol/ml to 3.14±1.29 nmol/ml) 14 days post chemotherapy (p=0.04). Moreover, the total plasma antioxidant capacity changed from 1.09±0.15 mmol/L to 1.02±0.14 mmol/L (p=0.005). Erythrocyte superoxide dismutase and glutathione peroxidase activity decreased over time from 1157.24±543.61 U/gHb to 984.01±419.09 U/gHb (p=0.04) and 46.96±13.70 U/gHb to 41.40±6.44 U/gHb (p=0.02), respectively.

Conclusion: In this study, an increase in malondialdehyde levels and a decrease in the levels of antioxidant enzymes and total antioxidant capacity were observed. It seems that chemotherapy by cytarabine and daunorubicin generates enormous amounts of free radicals in patients undergoing the treatment for AML. Use of antioxidant supplementation during chemotherapy i is discouraged as it may interfere with the generation of free radicals that may be a part of the therapeutic efficacy of these drugs.

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Background: Among all types of cancers, pancreatic cancer has poor prognosis with 5-year survival below 10%. In theory, alcohol intake may be a modifiable risk factor for pancreatic cancer due to its role in multiple carcinogenic and metabolic signaling pathways. In addition, alcohol consumption may lead to chronic pancreatitis which is underlying cause of pancreatic cancer. However, little is known about whether this factor is associated with pancreatic cancer. This study aimed to systematically review the cohort studies investigating the possible link between alcohol consumption and the morbidity or mortality of pancreatic cancer.
Methods: This study was carried out based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). All of cohort studies that assessed the association between alcohol intake and the risk of pancreatic cancer or death were included in this systematic review without a language restriction. Electronic databases including PubMed, Web of science, Scopus, and Google scholar were searched using the keywords "pancreatic cancer" and "alcohol" and similar words from 1990 to April 2021 to find the cohort studies.

Results: 858 articles were identified, of which 806 were excluded and the full-text of 52 papers were evaluated for the eligibility. Eventually, 22 articles were eligible and were included in this study. Many of the articles assessed the impacts of low to moderate alcohol intake. A comprehensive review of these studies showed that low to moderate alcohol consumption had a non-significant correlation with pancreatic cancer, while high alcohol consumption was significantly associated with the risk of pancreatic cancer or death. The results also revealed that high liquor consumption was associated with higher risk of pancreatic cancer. Nevertheless, the follow-up durations in most of these studies were shorter than that to lead to pancreatic cancer. Conclusion: Long-term heavy alcohol drinking can increase the morbidity or mortality of pancreatic cancer. Regarding that several genetic and environmental variations involve in the pathogenesis of this cancer, simultaneous control of these differences should be addressed to determine the net effect of alcohol drinking on pancreatic cancer.