محمد مهدی کوشیار

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by decreasing platelet count with the normal bone marrow and the absence of specific causes of thrombocytopenia. Corticosteroids are the first line of treatment and costly and complicated methods, such as splenectomy or immunosuppressive agents, are used as the second line of treatment. Alfalfa with scientific name of Medicago Sativa has warm temperament that traditional physicians have used as haemapoietic food from thousands years ago and its use with anticoagulants reduces their effectiveness. The aim of this study was to determine the effectiveness of alfalfa syrup on platelet count in patients with ITP.

This is a randomized, double-blind, placebo-controlled clinical trial that was done in Hematology Clinic Imam Reza Hospital, Mashhad, Iran. Forty patients were randomly divided into two groups of alfalfa syrup and placebo syrup. They received 5 cc of alfalfa or placebo syrup each 8 hours for 15 days. Blood samples were taken from patients before and at the end of treatment. Blood samples were taken for CBC, BT and platelet counts. The statistical method used was Paired-samples T test and independent-samples T test.

The results showed that there were no significant differences between the two groups in the laboratory tests at first, but after the intervention, the mean number of platelets and BT differences between the two groups was statistically significant (p=0.013 and p=0.018, respectively).

The use of a cheap and available vegetable as alfalfa can be effective in improving the platelet count in patients with ITP.

Adverse drug reactions (ADRs) are one of the most important problems in all hospitalized patients. It is especially more common and problematical in cancer chemotherapy. In this study we tried to evaluate the incidence of ADRs associated with chemotherapeutic drugs in colorectal and gastric cancer patients in a teaching hospital.
Material and A prospective observational study was carried out on patients with colorectal or gastric cancer who referred to outpatient chemotherapy unit of Imam Reza Hospital, Mashhad, Iran, between July and December 2016. The identified ADRs were assessed for causality, severity and preventability.
Among 121 patients (67 with colorectal cancer and 54 with gastric cancer) followed during 251 and 249 chemotherapy courses respectively, in 182 and 249 courses ADRs occurred. All patients with gastric cancer experienced at least one ADR but 28.4% of patients with colorectal cancer passed their chemotherapy course without any adverse reaction. Gastrointestinal tract complication and neurologic problems were the most common ADRs in gastric and colorectal cancer patients, respectively. Nausea and vomiting was significantly more common in gastric cancer patients who received EOX regimen and also muscular weakness in patients who received FOLFOX regimen. The same correlation was found between neuropathy and FOLFOX IV regimen in patients with colorectal cancer.
Patients undergoing cancer chemotherapy have higher chances to develop ADRs. Those patients on chemotherapy should be strictly monitored for the early detection and prompt management of the ADR to prevent morbidity and mortality

Breast carcinoma is the most common cause of cancer mortality among women globally. Primary and secondary prevention through avoiding known risk factors, screening for early detection of tumors with different methods as well as timely treatment, can be effective in reduction of the burden of this devastating disease. This can in turn prevent death and also increase survival in patients with breast cancer. Both environmental and genetic factors are involved in the pathogenesis of breast cancer. Multiple genetic factors can influence the risk and development of breast cancer. Identification of genetic variants including single nucleotide polymorphisms (SNPs), which are associated with the risk of breast cancer development, are mostly done through genetic association studies. It is demonstrated that SNP allele frequencies vary amongst different populations. It has been shown that genetic risk factors like variations in TOX high mobility group box family member 3 (TOX3), which affect the liability for neoplasm, play an important role in the development of breast cancer. Although TOX3 is expressed mainly in the brain, its expression in other tissues especially breast has also been reported. TOX3 maps to chromosome 16q12 and encodes the nuclear high-mobility group (HMG)-box. It has calcium (Ca2)-dependent transcriptional activities and is a co-factor of cAMP response element (CRE)-binding protein (CREB) and CREB-binding protein (CBP). TOX3, activated with Ca2, is related with activation of the promoter of some other genes including BCL2 and C3 complement and also CITED1 gene expression. It also induces activation of the c-fos promoter and therefore its expression. Genome-wide association studies (GWAS) in different populations including European, Asian and African-American have demonstrated that a SNP near its 5ʹ end and the promoter of TOX3 gene appears to be significantly associated with breast cancer susceptibility. Furthermore, breast cancer–associated SNPs lead to enhanced FOXA1 bindings and in turn, a reduction in TOX3 gene expression. This review has highlighted the importance of TOX3 function, SNPs and its association with breast cancer risk and also its potential effects on breast cancer treatment; TOX3 plays dual and somehow conflicting roles in cancer initiation and progression which remains to be further investigated.

Gene mutations of BRCA1 and BRCA2 in germline can cause risk of breast and ovarian cancers. BRCA1 and BRCA2 genes cause 20% of hereditary breast cancer. The majority of BRCA1 and BRCA2 mutations lead to premature protein termination. This study was performed with aim to investigate the role of BRCA1/2 mutations in risk of breast cancer and introduce some mutations associated with these genes.
In this systematic review, the information related to the role of BRCA1/2 genes in risk of breast cancer was obtained by searching in databases of PubMed, Scopus, Med-Line, Web of Science, Science Iranian Database and other related websites using the keywords of BRCA mutation, BRCA1, BRCA2, breast cancer and Iran during 1990 to 2015. Finally, 88 articles were chosen that were associated with BRCA1 and BRCA2 genes and their role in risk of breast cancer
This review paper shows more than ever importance of identifying the gene mutations of BRCA1 and BRCA2 carriers in different societies, especially in national and the necessity of planning for families with family history of breast cancer and also screening for mutations in these two genes is felt in clinical programs of the country.
BRCA1/2 genes have great importance and impact on the development and progression of breast cancer. Therefore, these genes can be considered as molecular markers in early detection of breast cancer.

Available genomic data and genome-wide association virtual studies provide the possibility of genetic markers detection known to be associated with complex diseases. Genome Wide Associated Studies (GWAS)، which involve direct testing of genetic polymorphisms in large series of disease cases versus controls، provide a powerful approach to identify lower penetrance alleles that cannot be already detected by genetic linkage studies. By utilizing computer and software systems، it is possible to detect the association of SNPs with diseases without prior knowledge of the function or position. GWAS has been conducted in five of the most common cancer types: breast، prostate، colorectal، lung، and melanoma. GWAS of the breast cancer was performed by simulation of 7 known SNPs on chromosomes 2، 5، 6، 8، 10، 11 and 16 for 10000 women. A simulation study was performed using GWASimulator software and data were analyzed by R software (SNPassoc package). The strongest associations were found for rs2981582 in the FGFR2 gene. SNPs rs889312، rs2180341 and rs3817198 were associated with breast cancer. However، SNPs rs13387042، rs2180341 and rs13281615 on chromosomes 2، 6، and 8 were not associated with the disease، which requires more cases and controls to be stimulated. The results of this research showed that the detection of SNPs associated with the disease was easily possible through employing virtual systems based on real data of Hap Map project using R software.

Anemia is a common problem among patients with cancer, particularly among those undergoing chemotherapy. The purpose of this study was to determine the association between hemoglobin levels and severity of fatigue and quality of life in cancer patients undergoing chemotherapy. This is a descriptive– correlative study that utilized a purposeful sampling. One hundred twenty one outpatients with cancer participated in this study. Data collected by interview. The instruments used included the sample selection and demographic data form, Fatigue Severity Scale, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). Hemoglobin level was reviewed from medical records. Grading of anemia based on hemoglobin level according to the National Cancer Institute classification. Prevalence of anemia in cancer patients undergoing chemotherapy was 63.6 percent; 57 percent had mild anemia and 6.4 percent had moderate to severe anemia. There were significant differences between mean score of severity of fatigue (p<0.001) and quality of life (p=0.003) in relation to hemoglobin level. There found negative significant correlation between hemoglobin levels and quality of life or severity of fatigue (p<0.001). Anemia is prevalent among cancer patients undergoing chemotherapy. During chemotherapy, decreased hemoglobin levels are associated with increased fatigue and reduced quality of life. Nurses can help by appropriate intervention and patient's education about self care intervention to reduce anemia and fatigue and also improve quality of life.

Nutrition plays a major role in cancer development and treatment. Weight loss is a common problem in patients with cancer that has been identified as an indicator of increased mortality and morbidity in cancer patients. The purpose of this study was to determinate the relationship of body mass index with severity of fatigue and quality of life in cancer patients undergoing chemotherapy.Methods and Materials: This study was a descriptive correlational study which utilized a purposeful sampling to select one hundred and twenty one outpatients with cancer. Data were collected by face-to-face interview using a questionnaire. The severity of fatigue and quality of life were respectively measured by fatigue severity scale and quality o life scale (EORTC QLQ-0).The analysis of data was carried out using Paired t-test. The findings showed a significant difference between mean of fatigue severity (P<0.00), quality of life (P<0.0) and BMI (p<0.00) before and after three cycles of chemotherapy. Also the scores of fatigue severity (P<0.008), quality of life (P<0.00) were significantly different during the three cycles of chemotherapy. In cancer patients undergoing chemotherapy weight loss leads to increased severity of fatigue and impaired quality of life. The nurses could help to reduce severity of fatigue and improve quality of life by appropriate interventions such as patient's self care education and also careful monitoring of patient's nutritional status.

Introduction & Anemia is common among patients with cancer, particularly among patients undergoing chemotherapy. Anemia leads to reduce survival following chemotherapy. The purpose of this study was to determine the relationship of anemia with severity of fatigue and quality of life in Cancer Patient Undergoing chemotherapy. This is descriptive –correlative study that utilized a purposeful sampling one hundred twenty one out patients with cancer participated in this study. Data collected by interview, the instruments used included: the sample selection and demographic data form, Fatigue Severity Scale, and Quality of life Questionnaire (EORTC QLQ-C30). Hemoglobin level was reviewed from medical records. Grading of anemia based on hemoglobin level according to the National Cancer Institute classification. The findings indicated that prevalence of anemia in cancer patients undergoing chemotherapy was (63.6%).There were significant differences between mean score of severity of fatigue (p<0.001) and quality of life (p=0.003)in relation to hemoglobin level. Negative significant correlation between hemoglobin level and all dimensions of quality of life and severity of fatigue. The severity of anemia is closely related to severity of fatigue and quality of life. During chemotherapy, decrease hemoglobin levels was associated with meaningful increase in fatigue and reduce dimensions of physical, role function, cognitional, social and overall quality of life.

Breast cancer with 22.6% is the most common cancer in Iranian women and mastectomy is the treatment of choice in 81% of cases posted for surgery. Mastectomy can evoke feelings of mutilation, altered body image and decreased sexual attractiveness and function leading to mood disorders. In the last decades, final purpose of treatment strategies in breast cancer is creation of a life with good quality. In this regards, concern is rising about the impact of surgical treatments, especially mastectomy on patient`s quality of life. This study was conducted to determine the relationship of mastectomy with mood and quality of life in breast cancer patients.

This descriptive-analytic study was done in 2005.Case group included mastectomy patients referring to the oncology clinics (n=50).The comparison group consisted of mammography candidates referring to women clinics in Imam Reza and Ghaeem Hospitals. Data collected was based on non-probability and purposeful sampling. The information collected included: demographic and medical information, social support questionnaire, POMS survey for measurement of mood. Quality of life was assessed with FPQOLI.

Pearson correlation coefficient showed a significant converse statistical relation between mood and quality of life score in mastectomy women (P<0.001). Independence T test showed that mood and quality of life in mastectomy group were lower than mammography candidate women (P=0.001, P<0.049). The general linear model test showed that group variable had the most effect on women`s mood (P<0.001). Also , mood was the most important factor that predicted level of quality of life in these women (P<0.001).

Lack of attention to psychological and spiritual status of the patients after mastectomy may provide conditions for unstable mood and can finally disrupt their quality of life. But, nurses can identify patients with psychological tensions and introduce them to consultancy centers to prevent mood disorders and promote their quality of life.

Introduction & Quality of life is a subjective and multi dimensional concept assessing physical, social, psychological and role function domains. cancer diagnosis and its therapy have a negative impact on quality of life. one type of cancer treatment is chemotherapy that administered to destroy cancer cells. the studies show that cancer treatment with side effect and toxicity that diminish quality of life. The purpose of this study was determine changes of quality of life in cancer patients before and after 3 cycle chemotherapy in selected hospitals of Tehran and shahid beheshty medical science university in 1380-81. This is a descriptive –correlative study that utilized a purposeful sampling. one hundred twenty one out patients with cancer participated in this study data was collected by interview. the instruments used included: the sample selection and demographic data form, social support questionnaire, fatigue severity scale, piper fatigue scale and quality o life scale. The finding of t- test indicated that a significant different between mean of quality of life(P<0.001) before and after 3 cycle chemotherapy. significant different was found between means of physical function (p<0.003) role function(p<0.001), psychological (p=0.006) domains before and after 3 cycle chemotherapy, but significant different was not found between cognitive and social domains before and after 3 cycle chemotherapy. Quality of life negatively affected during chemotherapy. The nurses by appropriate intervention and patient's education about self care intervention can help to reduce fatigue and side effects of chemotherapy and improve quality of life.

Introduction & cancer treatment relate fatigue is the most prevalent and distressing side effect of treatment for cancer patients. fatigue lead to decline emotional, psychosocial and physical functions and can be influence on the individual's quality of life. The purpose of this study was determine the intensity of fatigue in cancer patients before and after 3 cycle chemotherapy in selected hospitals of Tehran and shahid beheshty medical science university in 2001-2002. This is adiscriptive –correlative study that utilized a purposeful sampling. one hundred twenty one out patients with cancer participated in this study.data callectad by interview. the instruments used included: the sample selection and demographic data form, social support questionnaire, fatigue severity scale, piper fatigue scale and quality o life scale (qol-30) The finding indicated that a significant different between mean of intensity of fatigue(P<0.001) before and after 3 cycle chemotherapy. significant different was found between changes of intensity of fatigue with hope and uncertainty (P<0.001) and BMI(P=0.008),and significant positive correlation was found between intensity of fatigue with Hb and distressing symptom (P<0.001). in cancer patient intensity of fatigue increase over the course of chemotherapy. Loss of BMI, other side effects, hopeless, uncertainty, anemia lead to increase intensity of fatigue. Fatigue lead to decline emotional, psychosocial and physical functions and can be influence on the individual's quality of life. The nurses by appropriate intervention and patient's education about self care intervention can help to reduce fatigue and improve quality of life