School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 1 5 FA Alireza rajaie

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Goiter survey and urinary iodine concentration in 7-10-year-old children, Azarbayejan-Gharbi Province, 2001 7 11 FA shykholeslam R Hamisi A Ajami B Tashakori N padyab M azizi F Background: Iodine deficiency disorder (IDD) is a worldwide health problem. Parts of Iran, such as Azarbayejan-Gharbi, had been known as endemic areas for goiter. IDD was accepted as a priority health problem in our country and a National IDD Council was formed in 1989. This study was performed to evaluate the National IDD Council program in 2001 among 7-10-year-old children in Azarbayejan-Gharbi province. Materials and methods: In this cross sectional study, 1200 children (M/F ratio=1), aged 7-10 years, were selected and grading of goiter was performed in accordance to the WHO criteria. Urinary samples were obtained from 120 children and urinary iodine was measured using digestion method. Results: Total prevalence of goiter was 7.2% (6.7% in girls and 7.8% in boys). The median urinary iodine was 14.6µg/dl. 83.9% had urinary iodine of more than 10µg/dl, while 2.6% had urinary iodine levels of <5µg/dl. None of the candidates has urinary iodine of less the 2µg/dl. There was no significant difference between sexes and urban or rural areas. Conclusion: Results have revealed that the total prevalence of goiter has significantly decreased among children in Azarbayejan-Gharbi province, meanwhile, urinary iodine concentration of children has reached to WHO approved rate. Thus, Azarbayejan-Gharbi province could be classified among "iodine-deficiency-free" areas in Iran.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Osteoarthritis after open reduction and internal fixation of lisfranc fracture 13 17 FA F Madadi F Adib Background: Open reduction and internal fixation is the standard surgical approach for lisfranc fracture, however, osteoarthritis is a long term complication. We surveyed the frequency of osteoarthritis after open reduction and internal fixation of lisfranc fracture and its associated factors including accompanied fracture, delayed diagnosis and open or closed fracture. Materials and methods: Patients who suffered from lisfranc fracture between 1997 and 2005 and underwent open reduction and internal fixation at least 2 years ago were included. Tarsometatarsal osteoarthritis was investigated among these patients. Results: Of 94 patients, 44 were included with a mean follow up duration of 36 months, among whom, 34 had anatomic reduction while 12 (35.3%) developed osteoarthritis. Meanwhile, of 10 patients with non-anatomic reduction, 8 (80%) developed osteoarthritis. The difference is statistically significant (p=0.004). Unfortunately, 4 patients (9.1%) were misdiagnosed during the first visit, while 10 (22.7%) patients referred late. Accompanied fractures were reported in 34 (77%) patients. Conclusion: Higher prevalence of osteoarthritis among patients with non-anatomic reduction support the prior theory that open reduction and internal fixation could prevent further degenerative changes in lisfranc joint. , Adib F

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Clustering approach in DNA microarray analysis 19 25 FA H Alavimajd M Vahedi Y Mehrabi B Naghavi Background: Microarray DNA technology has paved the way for investigators to expressed thousands of genes in a short time. Analysis of this big amount of raw data includes normalization, clustering and classification. The present study surveys the application of clustering technique in microarray DNA analysis. Materials and methods: We analyzed data of Van’t Veer et al study dealing with BRCA1 and BRCA2 mutations in breast cancer. It was consisted of 18 patients with BRCA1 and 2 patients with BRCA2 mutation. Gene expression data were clustered using hierarchical and non-hierarchical approach. Then different clustering approaches were compared according to the actual classification with R software. Results: Hierarchical clustering showed a sensitivity of 94% and specificity of 100% in detecting BRCA1 gene. These figures were 89% and 100% for non-hierarchical clustering, respectively, indicating a satisfactory performance for both approaches. All clustering approaches classified sample No. 95 in BRCA2 group, however, clinical manifestations put her in BRCA1 group. Conclusion: With respect to satisfactory coincidence between clustering and actual classification results, clustering approach could be applied for cases when actual classification is missing.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Efficacy of dexamethasone in preventing post operative nausea and vomiting following thyroidectomy 27 31 FA H Ghaheri Najafabadi SR Entezari A Beygi Broujerdi Background: Postoperative nausea and vomiting (PONV) is among the most common complications after anesthesia. This study aimed to compare pre-induction use of placebo and dexamethasone on decreasing the incidence of nausea and vomiting after thyroidectomy in a group of Iranian women. Materials and methods: In this double-blind clinical trial, 42 patients undergoing thyroidectomy were randomly divided into two groups of equal size. Before the induction of anesthesia, normal saline was injected in placebo (P) group while 10mg dexamethasone was administered for the case group. The incidence of nausea and vomiting was recorded in recovery room, and during the first 24 hours following the surgery. Results: The incidence of nausea and vomiting showed a statistically significant decrease in patients receiving dexamethasone (p<0.0001). Conclusion: Use of 10mg dexamethasone before the induction of anesthesia may remarkably decrease the incidence of PONV, and is recommended for high risk groups especially in outpatient surgeries.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Comparing deproteinization methods for serum nitric oxide assay by Greiss reaction 33 37 FA A Ghasemi M Hedayati H Biabani A Khoshbaten AR Asgari Background: Nitric oxide (NO) is involved in numerous physiologic and phathophysiologic processes. Recently, further investigators have focused on serum NO determination. In our previous study, we validated a simple, cheap and rapid method for serum NO determination based on the Greiss reaction. Deproteinization is a necessary step for this reaction, thus, the present study was designed to assess different deproteinization methods for serum NO determination. Materials and methods: Ten common protein precipitating chemicals including methanol, ethanol, zinc sulfate, methanol/diethyl ether, acetonitrile, TCA, PCA, sodium tangstate, ammonium sulfate and filter were used for deproteinization of 42 human sera, while results were compared to filter separation as a reference. Serum NO levels were determined in 60 sera of adult human. Results: Data showed that correlation coefficient of precipitating agents: methanol, ethanol, zinc sulfate, methanol-diethylether, acetonitrile, TCA, PCA, sodium tangstate, ammonium sulfate against filter separation method were 0.84, 0.92, 0.91, 0.79, 0.88, 0.85, 0.93, 0.53, and 0.78, respectively (p<0.001). Methanol, ethanol and methanol/diethylether caused overestimation, while TCA, PCA, sodium tangstate, and ammonium sulfate caused underestimation of serum NO results. Serum NO level had normal distribution with mean ±SE of 33±1.3 μmol/L. Conclusion: Although different chemical protein precipitants are used for serum NO determination, our study revealed that zinc sulfate is the best choice for this purpose.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Frequency of hepatitis A virus antibodies in patients with hepatitis B and hepatitis C in Iran 39 42 FA AH Mohammad Alizadeh M Ranjbar F Keramat M Mamani M Rezazadeh Background: Superinfection of hepatitis A in chronic hepatitis B and C may worsen the course of disease. This study attempted to study frequency of hepatitis A virus antibodies in patients with hepatitis B and hepatitis C. Materials and methods: 115 hepatitis C and 56 hepatitis B patients who visited the Hepatitis Association of Hamedan province during 2004-2005 were enrolled. Hepatitis A virus antibodies (IgM, IgG) by ELISA, WBC, hemoglobin, platelet, AST and ALT were evaluated. Results: 32 patients with hepatitis B and 39 patients with hepatitis C refused the study. In 71 (85.5%) patients with hepatitis B, IgG-HAV-Ab and in one patient IgM-HAV-Ab was detected. 36 (92.3%) patients with hepatitis C had IgG-anti-HAV. Conclusion: Due to high frequency of HAV Ab, it is preferable to evaluate patients with hepatitis B and C for HAV-Ab instead of vaccination of all patients. .

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Diagnostic power of quantitative HCG in cervico-vaginal washings in women with premature rupture of membranes 43 47 FA N Kariman E Jafari HR Amiri Moghadam H Alavi Majd Background: Premature rupture of membranes (PROM), occurs in 2-25% of pregnant women. Traditionally, clinical and laboratory tests utilized for the diagnosis of PROM are fraught with both false positive and false negative results caused by various factors that result in an equivocal or delayed diagnosis. The absence of a non-invasive 'gold standard' for the diagnosis of PROM has led to the search for alternative biochemical markers. This research has been conducted to compare the diagnostic power of qualitative and quantitative HCG of cervicovaginal washings for the diagnosis of PROM.s Materials and methods: This Diagnostic-Experimental study was undertaken with cervico-vaginal samples collected from singleton pregnancies between 14-41 weeks of gestation. Totally 86 pregnant women referred to Vali-Asr Hospital, Zanjan, in 2006, were enrolled in this study. Subjects were divided in two groups: 43 subjects with confirmed PROM (amniotic fluid pooling (+), nitrazine paper test (+), and fern test (+)), and 43 women in the control group (amniotic fluid pooling (-), nitrazine paper test (–), and fern test (-)). Washings were then collected from the posterior vaginal fornix with the use of 5 ml of sterile saline irrigation and aspiration techniques. We measured HCG levels with the ELISA test. Result: The median HCG levels were 250.60 (mIU/mL) and 6.2 (mIU/mL) in PROM and control group respectively. With, 22 (mIU/mL) set as a cutoff value on the receiving operating characteristic curve, (ROC), sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were 95.3, 97.7, 97.6, 95.5 and 96%, respectively. Conclusion: Quantitative HCG measurement of cervico-vaginal washings was an accurate test for the diagnosis of PROM in our study.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Evaluation of the efficacy of random urine analysis with urinary tape for the determination of proteinuria and its comparison with 24-hours urine collection in gestational hypertension 49 53 FA N Khadem L Hafizi Background: Proteinuria is an important diagnostic sign of pre-eclampsia and hypertensive disorders of pregnancy (HDP). The purpose of this study was to compare the results of random urinalysis for proteinuria with standard 24-hour urinary protein. Materials and method: In this survey proteinuria in random urine was compared with standard 24- hours urinary protein excretion in 82 women with HDP, hospitalized in EmamReza Hospital, Mashad, between 1380 and 1381. Results: Findings showed random urinalysis values of ≥1+ proteinuria had a positive predictive value of 85% for predicting >300 mg per 24 hour, (defined as proteinuria). In contrast, values of negative protein and trace should not be used to rule out significant proteinuria because its negative predictive value was only 28% in hypertensive patients. Moreover, values of 3+ to 4+ proteinuria could not be used to diagnose severe preeclampsia because their positive predictive value was only 26%. Conclusion: Random urinalysis may fail to demonstrate significant proteinuria in HDP and this study suggests that 24-hour urine excretion should be measured for patients selected for termination of pregnancy.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Reliability and validity of OSCE in evaluating clinical skills of nursing students 55 59 FA M Moattari Sh Abdollah-Zargar M Mousavinasab N Zare P Beygi-Marvdast Background: Objective structured clinical examination (OSCE) is one of the preferable means of evaluating cognitive, emotional and psychomotor aspects of nursing students. The present study was designed to determine the reliability and validity of OSCE in evaluating clinical skills of nursing students. Materials and methods: For this descriptive study, 10 different skills of nursing students were selected. Then, 37 students performed these skills at 10 different OSCE stations, during which two experienced inspectors evaluated their performance. Finally, the correlation between OSCE scores and the mean theoretical and clinical performance scores of students was calculated. Meanwhile, the correlation between the total OSCE scores with OSCE score of each station was determined. Inspectors’ reliability (correlation between scores reported by inspectors at each station) was also calculated. Results: The correlation coefficient of OSCE scores and mean theoretical and clinical performance scores were 0.38 (p=0.031) and 0.52 (p=0.005), respectively. Correlation coefficient of inspectors’ reliability was in a range of 0.38-0.95. Conclusion: OSCE is strongly suggested as a reliable and valid means of evaluating nursing students’ clinical skills.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Comparing ginger with mefenamic acid and ibubrofen for the treatment of primary dysmenorrhea 61 65 FA G Ozgoli M Goli F Moattar N Valaie Background: Primary dysmenorrhea is a frequent entity with known side effects on life quality. Ginger has been shown to inhibit prostaglandins, thus, the present study was designed to compare ginger with mefenamic acid and ibubrofen for the treatment of primary dysmenorrhea in a group of students in dormitories affiliated to Isfahan and Shahid Beheshti University of Medical Sciences. Materials and methods: For this double-blinded clinical trial, 150 students with primary dysmenorrhea were enrolled. Subjects were matched according to dysmenorrheal severity, then, assigned in 3 equal groups of ginger (250mg), mefenamic acid (250mg), and ibubrofen (400mg) that were all prescribed 4 times a day for 3 days. Groups were matched according to the following criteria: age, age of menarche onset, weight, height, BMI, father’s position, maternal occupation and level of education, regular exercise, and duration, interval and amount of menses’ bleeding. Finally, verbal multidimensional scoring system was used to assess the efficacy of drugs on dysmenorrhea. ANOVA and chi square were used for data analysis. Results: Dysmenorrheal improvement did not differ significantly among ginger (64%), mefenamic acid (58%) and ibubrofen (66%) groups. Thus, ginger is as effective as mefenamic acid and ibubrofen in alleviating dysmenorrheal symptoms. Conclusion: Ginger is an effective drug for alleviating primary dysmenorrheal symptoms.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 The effect of cool dialysate on intradialytic hypotension among end stage renal disease patients 67 72 FA M Moattari P Azarhooshang A Abbasian GH ReisJalali AR Rajaeefard Background: Hypotension is the most frequent adverse event during hemodialysis. Cool dialysate is a simple and cost effective measure in treating intradialytic hypotension by stabilization of core body temperature. This study was designed to find out the effects of cool dialysate on the frequency of intradialytic hypotension, presenting symptoms and intervention measures used for patients undergoing hemodialysis Materials and method: In this randomized cross-over clinical trial, patients with intradialytic hypotension were detected based on the pre-defined inclusion criteria. Then, they were randomly assigned to treatment (cool dialysate) and control (conventional dialysis) groups. After 1 month, they crossed over as control and treatment groups. Results: Data analysis (paired t-test) revealed that cool dialysate was associated with decrease in frequency of hypotension and number of interventions while improving symptoms and an increment in systolic and diastolic blood pressure. Conclusion: Cool dialysate is an effective tool in maintaining intradilaytic hemodynamic stability, alleviating symptoms of hypotension and the interventions applied for intradialysate hypotension. Therefore, cool dialysate is recommended in hemodialysis patient.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Effects of boron and calcium supplementation on mechanical properties of bone in rats 73 78 FA MR Naghii G Torkaman M Mofid Background: The objective of this study was to consider the effects of boron (B) and calcium (Ca) supplementation on mechanical properties of bone tissues and mineral content of selected bones in rats. Materials and methods: Adult male Sprague Dawley rats underwent three different treatments with boron and calcium in their drinking water, while being fed ad libitum for 4weeks. Rats were placed into three treatment groups: group1 were given 2 mg B/d group 2, 300 mg Ca/d, and group 3, a combination of 2 mg B + 300 mg Ca/d. After the experimental period body weights were recorded and bone mechanical properties were determined on the tibiae, femurs, and fifth lumbar vertebral bones and the mineral contents of these bones was calculated as the ash percentage. Results: Bone mechanical properties were observed to be better after boron supplementation. The hardness of the lumbar vertebral bones tended to increase in all groups. The group receiving Boron supplementation demonstrated maximal hardness in all bones while calcium supplementation had the least effect however, in the case of lumbar vertebral bones, this negative effect was corrected in the presence of boron,. Highest mean energy to maximal load was shown with boron supplementation, demonstrating significant differences with Ca group in comparison with the controls, least difference in mean energy to maximal load, was seen in the Calcium group. There were no significant differences in energy and deformation with ultimate load among the four groups. There were no significant differences in ash weights among the four groups. Conclusions: Boron supplementation increased the bone mechanical properties in rats and its efficiency tended to be higher in lumbar vertebral bones.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Translation and validation of the Amsterdam Preoperative Anxiety and Information Scale (APAIS) for Iranian population 79 84 FA R Nikandish M Anvar A Avand N Habibi N Gahramani R Dorri Background: Although anesthesia and surgery have become safer and more successful than ever before, preoperative anxiety is still a common problem. In this study, we translated and validated the Amsterdam Preoperative Anxiety and Information Scale (APAIS) for Iranian population. Materials and methods: We first translated the English version into Farsi, then translated back into English. The translation to English was authorized by the correspondent author of English version (Tim Wysocki).The questionnaires were completed by 130 patients with A.S.A I and II scheduled for elective outpatient surgeries. They also completed 20-item Spielberger’s State Anxiety Inventory (STAI-State) questionnaire concurrently as a gold standard for evaluation of preoperative state anxiety. Results: Cronbach’s alpha was 0.84 for the anxiety scale and 0.82 for the need-for-information scale. The correlation between the anxiety items of the APAIS and the STAI-State was high (0.68) and the correlation between the information items and the STAI-State were intermediate (0.50). Factor analysis with oblique rotation revealed two factors which explained 72% of the total variance: anxiety and need-for-information. Female sex and need-for-information were independently associated with preoperative anxiety. Anxiety was significantly higher in females (9.30±4.12) than males (5.8±2.30) (P<0.001). Assuming APIAS for anxiety equal or more than 11 as cut-off point, 21% of our study patients were anxious and 68% of our patients had a positive-information attitude. Conclusion: Farsi version of APAIS is a valid and reliable instrument for evaluation of preoperative anxiety and information requirement. Gender and information requirement are independently associated with preoperative anxiety. .

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Knowledge of patients with cancer towards their disease status 85 90 FA MH Larizadeh R Malekpour-Afshar Background: Ethical issues arise in oncology more frequently than before. Informing patient of his/her disease status and prognosis is of utmost importance. The present study was designed to assess knowledge of patients with cancer towards their disease status in Kerman. Materials and methods: For this study, 150 patients with cancer referring to the radiotherapy-oncology ward of Shafa hospital in Kerman were interviewed. We attempted to find out the following issues: Patients’ knowledge towards their diagnosis, prognosis, etiology, duration and probable side effects of treatment. Then, the association between patients’ knowledge and studied factors was determined. Results: Of 150 patients, 53 (35.3%) were completely informed of their disease while 11 patients (7.3%) were aware of the prognosis. Totally, 63(42%), 16(10.7%) and 106(70.7%) of patients were aware of the disease complications, etiology and the treatment duration, respectively. 58 patients (38.7%) were involved in decision making about their treatment protocol. Patients’ knowledge was associated with level of education, place and type of treatment (p<0.05). Conclusion: Iranian patients with cancer were not sufficiently informed of their disease status.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Mechanism of drug resistant in cancer 91 97 FA F Fatemi A Dadkhah M Honardoost M Ebrahimi M Hedayati M Shadnoush I Alipourfard Some varieties of human cancers become resistant, or, are intrinsically resistant to treatment with conventional drug therapies. This phenomenon is due largely to over-expression of the ATP binding cassette, (ABC), super-family of membrane transporters. In this regard, 170 kDa plasma membrane ATP-dependent pump, known as P-glycoprotein are the most important. Other members of multi-drug resistance associated proteins, (MRP), are also involved in multi drug resistance. The function of ABC protein in normal cell is translocation of the endogenous substrate. Ability of cancer cells to become simultaneously resistant to different drugs remains a significant impediment to successful chemotherapy. This review focuses on the mechanism of multi-drug resistance and also gives a brief account of this super family.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 1 2007 4 1 Primary plasma cell leukemia: effective treatment with intermediate dose Melphalan 99 101 FA M Ghadiani H Rahimi H Rezvani H Attarian Primary Plasma cell Leukemia (PCL) is a rare disease with no standard treatment, although, combination chemotherapy, BMT and intermediate dose melphalan have been shown to be effective, in some case reports. Patients usually present with anemia, thrombocytopenia, hypercalcemia, and renal failure. Diagnosis is confirmed by peripheral and bone marrow examination. We recently had a case in our department. A 43 years old gentleman presented with history of fatigue, weakness, weight loss, dyspnea and bone pain. Diagnosis of PCL was confirmed by PBS and bone marrow exam. The patient was treated using single intermediate dose melphalan (60 mg/m2/ IV) plus Dexamethasone with G–CSF support after 3 weeks, complete remission was achieved. In the last visit, done 9 months after treatment, he was doing well clinically and his Lab data were normal. This case report confirmed the efficacy of intermediate dose of melphalan in the management of plasma cell leukemia.