2023 CiteScore: 1.3
pISSN: 2008-3009
eISSN: 2008-2207
Editor-in-Chief:
Ardeshir Ghavamzadeh, MD.
This journal is a member of, and subscribes to the principles of, the Committee on Publication Ethics (COPE).
Vol 5, No 1 (2011)
Articles
-
Introduction: It is an unfamiliar, frightening and stressful experience for the parents of a child who is undergoing bone marrow transplantation. It is impossible to propose an effective caring method without considering all dimensions related to such experience.
Objective: The purpose of this study was to describe and understand the lived experiences of parents whose children were undergoing bone marrow transplantation process.
Methods: This research was a phenomenological study in which parents of 6 children with bone marrow transplantation were participated. Data collection method was semi- structured and profound, in-depth, face to face interviews. Data then were analyzed using interpretative phenomenological approach.
Results: Four major themes emerged from the data: 1) pending between dread and hope of the transplantation result, 2) exalting spirituality, 3) worry about circumstantial difficulties, and finally 4) life lessons learned.
Conclusion: During bone marrow transplantation process, parents of the children who undergoing transplantation, are experiencing a lot of problems, affections, difficulties, dreads, tensions, emotional conflictions and at the same time they learn a lot.
Implications for Practice: It should be acknowledged for nurses to be more sensitive to pay attention to parents' needs during their children bone marrow transplantation. Nurses need to recognize the power of spiritual factors which may help parents in coping with circumstantial difficulties of the bone marrow transplantation. -
Introduction: Acute promyelocytic leukemia treatment revolutionized by new tretaMNETS. Currently number of patinets who undergoe hematopoietic stem cell transplantation decrased so experience with this modality is limited. Here we report our experience with stem cell transplantation in acute promyelocytic leukemia patients. Design and setting: retrospective, single center
Methods: between year 2000 and 2011 we performed 20 HSCT in APL. Median age of patients was 25 year old. Patients received 3 autologous and 17 allogeneic HSCT from their HLA full match sibling donor. Different type of conditioning regimens applied for them. We used Cyclosporine and Methotraxtae as prophylaxis of GVHD after allogeneic HSCT.
Results: Hematopoietic stem cell engraftment observed in all cases. Acute GVHD was mild to moderate in all except one and was manageable.one patient dies due to aGVHD. Chronic GVHD was extensive in 2 cases and one mortality observed due to sever cGVHD. Mortality rate was 35% with a median follow up of 3.5 years. Five patinets died due to their primary disease relapse after HSCT. Three years DFS and OS were 63.1 and 77.2% respectively.
Conclusion: hematopoietic stem cell transplantation is an acceptable consolidation for APL. Choosing between autologous or allogeneic transplantation, need facilities such as reliable method for molecular remission detection before HSCT and also close and reliable follow up of patients with clinical and molecular parameters. -
Introductio: Hematopoietic stem cell transplants (HSCT) are considered as treatment options for patients with solid tumors. Transplant numbers have changed significantly over the last decade. We have done Autologous and Allogeneic HSCT for treatment of solid tumor patients in our center.
Methods: In order to show the transplant effect on solid tumor treatment, we collected data from 71 patients (7 allogeneic, and 64 autologous) who had undergone HSCT from 1991 to 2011 in our center. The median age of patients was 19.5 years (range: 2-58). The Male/Female ratio was 41/30. The most common transplant diseases were Neuroblastoma (18, 25.7%), Germ Cell Tumors (13, 18.6%) and Breast Cancer (11, 15.7%). 67 patients (95.7%) received peripheral blood and the 3 other ones (4.3%) received bone marrow as a source of SCT.
Results: The median time of hospitalization after high-dose therapy was 24 days (range: 11-50 days; 23 days for autologous and 29 days for allogeneic patients). At present, 57 patients (80%) are still alive with median follow-up of 9 months. Transplant-related mortality (TRM) was 4.3%. The causes of death were progressive disease, metastasis and multi-organ failure. 2-year overall and disease-free survivals were 81.7% and 72%, respectively (for the autologous patients overall and disease-free survivals were 80.7% and 71.1%, respectively). Among 7 patients with allogeneic transplantation, 2 developed acute-graft-versus host disease (GVHD) and 4 developed chronic GVHD. One patient had chronic GVHD following acute GVHD.
Conclusion: Our study reveals promising results of HSCT in the treatment of some solid tumors. In other hand, more additional trial study is needed. -
Introduction: Methotrexate (MTX) is an anti folate drug that used in malignant and non malignant patients. The usage of high dose methotrexate was limited to patients with: Osteogenic sarcoma, Ewing sarcoma and Lymphoma. The aim this study was to determine the toxicity or side effects of very high dose methotrexate (8-10 gr/m2/cycle). This study is the first study in Iranian patients and one of few study in world wide with this dosage and number of patients.
Patients and methods: In a prospective study on all patients with osteogenic sarcoma, Ewing sarcoma , and lymphoma that candidate for high dose MTX (mean total dosage was 27 gr/m2/case without any underlying disease, and after full physical examination and performing necessary paraclinical tests (Na, K, BUN, Cr, Uric acid, AST, ALT, Bilirubin, and ECG entered and information was filled for all of them prior and after the every cycle. The follow up visit include: repeated physical examination and duration of its was at least 6 months.
Results: There were 102 cases, 60 cases were male (58.8%), 42 female (41.2%), median age was 19.5 (5-80), Osteogenic sarcoma and Ewing sarcoma 87 cases (49/male and 38/female), 15 cases were Lymphoma (11/male, 4/female). Total course of MTX therapy was 273 (median courses were 2.67/patient). Our result revealed: Abdominal pain due to hepatomrgally was not obsereved, rising in bilirubin and alkaline phosphetase were not observed, but rising in AST and ALT were the most common liver toxicity due to high dose MTX and detail were: this toxicity was in 23 cases (46.9%) [11/men (18.3%) and 12/female (28.6%)] respectively. The maximum toxicity was grade 2 toxicity according to NCI criteria. All of them resolved spontaneously without any specific management and treatment except watch and wait.
Conclusion: This study revealed that the usage of very high dose methotrexate had liver toxicity but these toxicities were limited to abnormal AST and ALT. All of these toxicities were transient and resolved without any scar on liver function after cessation of therapy. After at least 6 months follow up we didn’t see any abnormality. -
Introduction: Acute Lymphoblastic Leukemia (ALL) is the most worldwide common type of childhood cancer. Methylenetetrahydrofolate reductase (MTHFR) and 5-methyltetrahydrofolate-homocysteine methyltransferase (MTR) are crucial enzymes in folate pathways. Folate availability is critical factor for DNA integrity, required for the transfer of methyl group in the biosynthesis of thymidilate.
Procedure: In present study, we have conducted a case control study from north Indian states to correlate the effect of two SNPs of MTHFR (677C→T and 1298A→C) and MTR (2756A→G) and the risk of childhood ALL. One hundred and twenty five bone marrows and peripheral blood samples and 100 sex-age matched healthy controls were obtained and analyzed by PCR-RFLP method.
Results: Statistically, no significant differences were observed between patients and controls for different genotypes (p>0.05), also significant different on risk of ALL in individuals having genotype of MTHFR 677TT (OR=0.61, 95% CI=0.21-1.77) and MTHFR 1298CC (OR=0.56, 95% CI=0.18-1.68) was not observed. Statistically, the correlation of variants of MTR gene and risk of ALL was not observed.
Conclusions:The difference in distribution of possible combined genotypes of MTHFR (677C→T, 1298A→C) and MTR (2756A→G) between patients and controls were statistically insignificant. -
Introduction: Cardiac dysfunctions have been well known in patients with Major thalassemia. Some studies have focused on differences in blood pressure and heart rate between these patients and normal population, while this view has not been proven in other studies. Given the importance of hemodynamic factors in the health of these individuals, we intend to test the hypothesis as to whether or not hemodynamic factors of these patients differ from normal subjects.
Methods: Patients were selected from among the thalassemic patients referred to a blood clinic of one of the third-level hospitals in Tehran. Finally, 50 patients and 50 normal subjects were studied in two groups. All subjects have been assessed using Holter monitoring. Mean average systolic blood pressure and heart rate of subjects were recorded for a period of 24 hours. In addition, demographic data on the subjects, and some laboratory tests (such as serum lipid profile and glucose levels of the patients) were also determined and compared between the two groups.
Results: 100 people were evaluated in two groups, including 50 patients with thalassemia major and 50 normal subjects, matched by age and gender. The mean age of the subjects was 16.3 ± 6.7 years; and there is no significant difference in mean age of both groups.23 female patients (46%) were in the case group, and 21 female patients (42%) were in the healthy group, the ratio for which there is no statistically significant difference between the two groups (P> 0. 05). The average level of serum glucose, lipid profiles, as well as none of the hemodynamic factors had no statistically significant difference in the two groups.Only the mean systolic blood pressure was significantly lower in male patients than among men without the disease.
Discussion: Despite the lack of difference in blood pressure between the case group and others, it seems that gender could plays a protective role against cardiovascular diseases in men with thalassemia major. -
The case of a 52 old women with Hodgkin’s disease of 15 years duration is described. During 4 months ago when she be in the remission phase during every 6 months her follow up she complaint with paranoid minds, urinary incontinency, headache, dizziness and blurred vision started. Papilledema and left hemiparesia were detected. Brain MRI pointed to intracranial invasion by the disease. Therapeutic test with steroids brought to amelioration; therefore, subsequent skull irradiation and chemotherapy were given which improved her condition markedly. For the diagnosis we need newer diagnostic procedures that enable for correct diagnosis of intracranial involvement in Hodgkin’s disease. In doubtful cases, therapeutic test with steroids, followed by chemotherapy and skull irradiation, are indicated, and surgery should be advised only if these measures fail.
-
Introduction: Fournier's gangrene or necrotizing fasciitis of external genitalia is a medical emergency. It was reported in cases of acute promyelocytic leukemia (APL) before and during induction therapy with all-trans retinoic acid (ATRA).We present a case of APL that developed Fournier's gangrene during ATRA therapy.
