Tehran University Medical Journal

Background: Leishmaniasis is a zoonosis disease. About 350 million people are at risk of developing a disease, with 1.5 to 2 million new cases every year in the world. The aim of this study was to determine the space-time clusters of cutaneous leishmaniasis in north of Khuzestan Province, Iran.
Methods: In this cross-sectional study, the annual cutaneous leishmaniasis incidence per 100,000 individuals in each county was determined for the past five years. Reported from 2011 to 2015 in North of Khuzestan Province, Iran. Geographical information system (GIS) and spatial scan statistic method were used to identify spatial clusters of cutaneous leishmaniasis cases at the county level. Pure retrospective temporal analysis scanning was performed to detect the temporal clusters of cutaneous leishmaniasis cases with high rates using the discrete Poisson model. The space-time cluster was detected with high rates through the retrospective space-time analysis scanning using the discrete Poisson model.
Results: The overall cutaneous leishmaniasis incidence increased from 2011 to 2015. A total of 3 high-risk counties were determined through Local Moran’s I analysis from 2011 to 2015. Local Moran’s I enabled the detection of the spatial autocorrelation for a county with its adjacent county. The method of spatial scan statistics identified different 11 significant spatial clusters. The space-time clustering analysis determined that the most likely cluster included 11 counties, and the time frame was October 2014. The secondary cluster included one counties in October 2014. The tertiary cluster included six counties, and the time frame was from June 2014 to November 2015.
Conclusion: Spatial and temporal clusters of cutaneous leishmaniasis have increased in the northern region of Khuzestan Province, and most clusters have occurred in November.

Background: Since numerous chemotherapy regimens for the treatment of patients suffering from acute lymphoid leukemia (ALL) have been recently developed, having basic information about the previous results of using the Hyper-CVAD regimen in order to compare with other common chemotherapy regimens is essential. The aim of this study was to evaluate demographic, clinical and outcome of ALL patients receiving Hyper-CVAD regimen.
Methods: In this retrospective study, nighty eligible ALL patients treated with the Hyper-CVAD chemotherapy regimen in Omid Hospital, Isfahan, Iran during April 2016 till April 2019 were considered. We evaluated the demographic variables, pathological data and other clinical factors by an information sheet designed by main investigator. The main purpose of this study was to evaluate overall survival, progression-free survival, and overall response rate of patients along with patients’ clinical characteristics and other relevant factors using Kaplan-Meier or Cox-regression and other statistical analyses. 

Results: The mean overall survival and the median survival of patients were 44.8±2.93 and 36.7±7.47 months; respectively. Also the mean progression free survival of patients was 44.44±3.30 months. More than 84.4% of patients encountered complete remission (CR) after receiving Hyper-CVAD regimen. Reaching to CR had positive significant effects on patients’ overall survival and median survival. However, the bone marrow transplantation variable alone did not affect the patients’ overall survival. The variables such as being B/T Cell ALL, Philadelphia, myeloid marker, and central nervous system involvement did not affect the overall survival of patients but the relapse index indicated the significant effects. The median survival time is higher in patients with no relapse episode. None of the initial lab data had any significant effects on patients’ overall survival. Conclusion: For the first time in Iran, we have obtained the mean survival outcome of ALL patients after applying the Hyper-CVAD regimen. According to the results, the mean overall survival, progression free survival and other survival items in Iranian patients suffering from ALL and receiving Hyper-CVAD regimen were in consistent with previous studies in the world.

Background: The use of mesh is considered one of the most effective methods and is considered the method of choice in hernia repair. However, the debate about the choice of mesh type still persists. Therefore, in the present study, the results of using ultra-light Prolene mesh with standard Prolene mesh in hernia repair surgery were compared.
Methods: The present study is a double-blind, randomized, controlled clinical trial that was conducted at Shahid Mohammadi Hospital in Bandar Abbas. Demographic information including age, sex, height, and weight were recorded in a checklist. Patients were randomly assigned to two groups. Each group used Prolene mesh in the first group and ultra-light Prolene mesh in the second group for repair. Hernia repair was performed by the surgeon using the Lebakhstein method.
Results: 119 patients were included in the study. 70 patients (57.4%) had direct hernia and 52 patients (42.6%) had indirect hernia. The mean age of the Prolene group was 43.8±7.49 and the ultra-light Prolene group was 44.32±8.91 years (P=.713). The mean BMI in the Prolene group was 29.94±3.43 and in the ultra-light Parwan group was 29.66±3.76 (P=.673). Wound infection was not observed in either group. Chronic pain was 14.5 in the Prolene group and 10.3 in the ultra-light Prolene group (P=.490). Administrative retention was 6.3 in the Prolene group and 8.5 in the ultra-light Prolene group (P=.738). The recurrence rate 3 months after surgery was 0 in the Prolene group and 1 case (1.7%) in the ultra-light Prolene group (P=.487). The recurrence rate 12 months after surgery was 2 cases (3.2%) in the Prolene group and 3 cases (5.2%) in the ultralight Prolene group (P=. 672). The time to complete recovery was 6.94±1.63 days in the Prolene group and 6.68±1.64 days in the ultralight Prolene group (P=. 368). There was no significant difference in pain intensity at 2, 6, and 24 hours after surgery between the two study groups.
Conclusion:  Both Prolene and ultralight Prolene mesh have relatively similar efficacy in inguinal hernia repair. Although the advantages of ultralight Prolene mesh, such as pain intensity, chronic pain, and faster onset of motion, were slightly different in the ultralight Prolene group, the recurrence rate was slightly higher in the ultralight Prolene group.