Tehran University Medical Journal

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Background: Hypomagnesemia is commonly encountered in patients with a wide variety of diseases including subarachnoid hemorrhage (SAH), cardiovascular emergencies, head trauma, migraine attacks, seizure and preeclampsia. It seems to be associated with a poor clinical outcome. This study considers the prevalence and temporal distribution of hypomagnesemia after aneurysmal SAH and its correlation with the severity of SAH, delayed cerebral ischemia (DCI) as well as the neurological outcome after a period of three months.

Methods: Between 2003 and 2008, 60 patients were admitted to the emergency ward of Imam Khomeini Hospital with acute SAH. Serum magnesium levels were measured during the first 72 hours, days 4-7, and second and third weeks after SAH. The three-month outcome was assessed according to the Glasgow Outcome Scale (GOS). Clinical SAH grading was performed according to the criteria of the World Federation of Neurological Surgeons (WFNS) and the patients were allocated to "Good" (GOS = 4, 5) and "Poor" (GOS= 1-3) outcome groups. The prevalence of hypomagnesemia was assessed in both patient groups. Fisher exact test was used to analyze data.

Results: Hypomagnesemia occurred in 22% of patients during the first 72 hours after SAH. It was associated with more prevalent DCI (p<0.05), whereas low serum magnesium levels during days 4-7 17% of patients) and the second week (22% of patients) after SAH were correlated with poor clinical outcome (p<0.05). No correlation was found between first 72 hour-hypomagnesemia and poor clinical outcome at three months.

Conclusion: Hypomagnesemia occurs after aneurysmal SAH and it may predict the occurrence of DCI, while low serum magnesium levels during days 4-7 and within the second week of event predict poor clinical outcome at three months. Treatment of this electrolyte disturbance may have a favourable effect on the clinical outcome of patients with aneurysmal SAH.

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Background: Sepsis is the leading cause of hospital admission and mortality. One marker for differentiation between infectious and non-infectious diseases is serum procalcitonin (PCT) level. The goal of this study was evaluation of serum procalcitonin level for differentiation among infectious & non infectious systemic inflammatory response syndrome (SIRS).
Methods: In a cross sectional study 263 patients with probable symptoms of sepsis that admitted to emergency department of Imam Khomeini Hospital Complex in Tehran, Iran, between 2006 and 2008, were evaluated for serum procalcitonin level by semi quantitative method. The clinical findings, demographic and laboratory data were identified by reviewing the medical notes.
Results: A total of 263 patients enrolled in the study. Mean age in study patients was 46.9 year (20.7) and most of the patients were male (65.8%). In 104 patients (39.5%) serum procalcitonin level was less than 0.5 (ng/ml), in 49 patients (18.6%) was between 0.5 and 2 (ng/ml), in 74 patients (28.1%) was between 2 and 10 (ng/ml) and in 36 patients (13.8%) was more than 10 (ng/ml). Sixty three patients (60.6%) with PCT<0.5ng/ml, had non-infectious SIRS, while all patients with PCT≥10ng/ml, had infectious SIRS. Procalcitonin level in patients with infectious SIRS was significantly more than patients with non-infectious SIRS (p<0.0001). Sensitivity of test for cut off point of 0.5, 2 and 10 (ng/ml) were 89.2%, 67.1% and 22.8% respectively, and its specificity for cut off points of 0.5, two and 10 were 82.9%, 96.2% and 100% respectively.
Conclusions: Procalcitonin level in combination with an appropriate clinical assessment can help us in beginning of antibiotic therapy timely and improve diagnostic and prognostic evaluation of patients with sepsis.

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Background: Meningiomas are among the most common tumors of the brain. Skull base meningiomas comprise s major part of brain meningiomas. They are difficult to treat because of proximity to major vital neuro-vascular structures which makes their surgical resection hazardous and fraught with a high rate of complications. Radiosurgery is considered as an alternative efficient way to treat them, which targets the tumor and its supplying vasculature. The standard treatment consists of tumor eradication and its supplying vessels through homogeneous dose of 201 rays of cobalt 60 source. Methods: In a case-series study, we report 230 meningiomas referred to Iraninan Gamma Knife Center, treated by radiosurgery with type C Gamma Knife. Radio-surgery was performed at a mean dose of 15 Gy and 50% isodose. Results: Two hundred and thirty of all meningioma cases refered to our institute were skull base lesions. Eighty (35%) were new case and the rest were previously treated microsurgically one or more times. None of the patients died after treatment and the most common post-operative complications were headache (30 patients) and peri- tumoral edema (12 patients). Conclusion: Tumoral control is defined as reduced tumor volume or as no change in tumor volume. Tumor control was achieved in 218 (95%) patients. In those who were not treated microsurgically, clinical improvement was more pronounced. Thus when suitable (favorable tumor size and absence of progressive mass effect signs) the patients could be primarily treated with Gamma knife. Other patients could be managed complementarily with radiosurgery after they are treated surgically.

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Mesenchymal Stem Cells (MSCs) are well known as the regulator of the immune system. These multipotent non-hematopoietic progenitor cells have been originally isolated from bone marrow, and later on found in several other tissues, such as skeletal muscle, umbilical cord blood, adipose and fetal liver tissues. Immunomodulatory effects of MSCs on a variety of immune cells such as T and B lymphocytes, Natural Killer cells (NK), neutrophils, macrophages and dendritic cells, has made a good candidate of them for the treatment of inflammatory disorders, particularly autoimmune diseases such as multiple sclerosis and rheumatoid arthritis. In addition, several studies have indicated mechanisms by which MSCs could reduce immune cell proliferation and activation leading to immune tolerance induction. Since T lymphocytes are considered as the most important immune cells, effect of MSCs on the activity of these cells has a very special significance to direct immune response. Under various conditions, T-lymphocytes have different phenotype and performance and can be differentiated into particular subtype such as regulatory T cells. Both in vitro and in vivo studies have indicated that MSCs modulate innate and adaptive immune system by promoting generation of CD4+CD25+ T regulatory cells which have important role in immune tolerance induction and autoimmune disease prevention. MSCs are able to block pro-inflammatory and increase anti-inflammatory cytokines secretion. So such unique immunomodulatory features make MSCs ideal candidates for clinical application as immunosuppressants which can be considered for autoimmune diseases treatment. Therefore, in this short-review, we attempt to focus mainly on the existing information about MSCs in association with immunomodulatory function of them on the immune system. In addition, the possible mechanisms and the performance impact of MSCs in autoimmune diseases improvement are discussed here. However, increasing knowledge of how MSCs will influence on the immune system suppression, leading us to better use of these cells as a promising tool in the treatment of autoimmune diseases.

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