School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 105 106 FA

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 107 108 FA

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Effects of L-carnitine supplements on inflammatory cytokines, CRP and oxidative stress in hemodialysis patients 109 116 FA A Shakeri H Tabibi A Nobakht-Haghighi M Hedayati M Chamari Background: Inflammation and oxidative stress are common in patients with chronic renal disease, including hemodialysis patients. The present study was designed to investigate the effects of L-carnitine supplements on inflammatory cytokines, CRP and oxidative stress in hemodialysis patients. Materials and methods: The study was a randomized clinical trial. Thirty-six hemodialysis patients, (23 males and 13 females), were randomly assigned to either carnitine group or the control group. The patients in the carnitine group received 1000 mg/d oral L-carnitine for 12 weeks while the control group did not receive any L-carnitine supplement during the study. At the baseline and the end of 12th week of the study, 5 ml. blood was collected after a 12 to 14-hour fast from each patient before dialysis and then serum free carnitine, CRP, IL-1β, IL-6, TNF-α and ox-LDL were measured. Results: Mean serum free carnitine concentration increased significantly, by 86%, in the carnitine group at the end of 12th week as compared to the baseline (P<0.001), while serum CRP and IL-6 decreased significantly, by 29% (P<0.05) and 61% (P<0.001), respectively. No significant changes were observed in the serum concentrations of free carnitine, CRP and IL-6 in the control group during the study. There were no significant differences between mean changes of serum IL-1β, TNF-α and ox-LDL concentrations in the two groups. Conclusion: This study indicated that L-carnitine supplement could improve carnitine deficiency and decrease inflammatory markers of CRP and IL-6 in hemodialysis patients.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Early Nasal CPAP treatment in premature neonates 117 121 FA N Rostami M Attarian Background: Respiratory distress syndrome (RDS) is a major cause of mortality among premature neonates. The present study was conducted to find out whether early nasal CPAP therapy could eliminate the need for mechanical ventilation in premature neonates with RDS. Materials and methods: For this clinical trial, premature neonates with RDS during the first 6 hours following the delivery were assigned in either case or control group. Case group received early treatment with nasal CPAP, however, standard treatments were applied for controls based on arterial blood gas analysis. Results: Totally, 25 cases and 22 controls with the mean gestational age of 31.3±2.6 weeks and weight of 1621±540gr. Totally, 68% of controls versus 40.9% of cases died (p=0.06). However, 80% of controls and 36.4% of cases required mechanical ventilation (p=0.006) that lasted averagely 2.9±2.6 days for controls and 0.68±1.3 days for cases (p=0.0009). Surfactant was injected in 48% of controls and 9.1% of cases (p=0.009). Finally, pneumothorax occurrence, oxygen therapy, and duration of hospitalization in NICU did not significantly differ between groups. Conclusions: Early therapy with nasal CPAP could eliminate the need for mechanical ventilation, and surfactant in premature neonates with RDS. Thus, application of nasal CPAP in centers lack NICU and respirator is strongly suggested.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Ferritin concentration of mothers' serum linear models for pridicting weight and height of new born babies 123 128 FA R Vazirinejad A Esmailie M Sadrmohammadi M Kazemi Gh Hasanshahi M Rezaiean Background: Iron deficiency anemia in pregnant women may result in detrimental consequences for their babies. Controversy exists between the findings of previous investigations conducted to explore the association between iron deficiency in the mothers and the outcome of pregnancy. This study is conducted to determine evidence regarding this association. Material and methods: A group of 120 eligible respondents were randomly selected from the list of all women who had given birth between 1st January and 30th March 2005, in Rafsanjan county hospitals. A study checklist was completed for 600 mothers and blood samples were taken from the group of 120 women eligible for inclusion in the study after receiving their second consent. Weight and height of babies were accurately measured at birth. Data including birth weight and birth height were analyzed using SPSS and parametric, (t-test, Correlation, Hierarchical Multiple Regression), and non-parametric, (Chi-square, Mann-Witney U), tests were used where appropriate. Results: In different groups of respondents, mothers’ age, educational status, infants’ sex or gestational age revealed no association with the ferritin concentration of mothers' serum, thus eliminating the effect of confounders. A significant positive correlation was found between the ferritin concentration and the weight, (r= 0.434, n=120, p<0.001), and also the height, (r=0.396, n=120, p<0.001), of babies. Conclusion: Linear models revealed that ferritin concentration of mothers’ serum in the 24 hours prior to delivery could be suitable to predict both birth weight and birth height of newborns. This emphasizes the importance of a positive iron balance in pregnant women. Controlling the diet of pregnant women to provide enough iron in their food seems appropriate for improving pregnancy outcome.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Role of mother’s preference for the type of 129 132 FA F Yassaee B Mohseni Background: The rate of cesarean section in our society is increasing every day. This research was done to study the effects of mother’s personal preference about the mode of delivery on the outcome of delivery in pregnant women who recieved perinatal care in Taleghani and Mahdieh Hospitals. Material and methods: This cross-sectional study was done on 160 women pregnant with there first babies. Mothers’ characteristics: First pregnancy, no systemic disease, no indication for cesarean section before labor pain, no history of infertility, non-smokers. All subjects were interviewed about their preferences regarding the method of delivery. Results: Ninety-four women, (58.8%), preferred to have a normal vaginal delivery, and 66, (41.2%), chose cesarean section. From the first group, 65 (61.3%) cases and from the second group, 41 (38.7%) cases came back to the same hospital for delivery. The rate of cesarean section in the first group was 12.3% and in the second group was 34.1% (P<0.01). Conclusion: There is a positive association between mother's wish about the method of delivery and it’s outcome.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Association between body mass index (BMI) and sociodemographic factors among Iranian females aged 15-44 years 133 139 FA F Farbakhsh T Shafieezadeh A Ramezankhani A Mohammadalizadeh M Shadnoush Background: With respect to the high expenses of obesity treatment and its associated complications, there is an urgent need for a suitable approach towards behavioral change in obese subjects. The present study was conducted to determine the association between body mass index (BMI) and sociodemographic factors among Iranian females aged 15-44 years. Materials and methods: For this cross sectional study, 2969 females aged 15-44 years were selected through a cluster sampling. We evaluated BMI and its association with occupation, educational level, family size, place of residence, marital status, and age. Logistic regression analysis was used to eliminate the effect of confounding factors. Results: The mean BMI was 25.6±5.2kg/m2, while 46.2% of subjects had normal BMI, however, 4.6% had severe obesity. BMI was significantly higher among 35-44 years old, married, illiterate, and house keeper females. Regression analysis showed that illiteracy and lower educational level could increase BMI. Conclusion: Our results revealed that the mean BMI of Iranian females exceeds normal value, however, during a 5-year period the frequency of obesity did not alter significantly among females aged >20 years. Age increment, illiteracy, marriage, and housekeeping are associated with higher BMI level.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Serum iron, hepatic iron deposition, and inflammatory 141 145 FA AH Mohammadalizadeh F Fallahian M Alavian F Rahimi M Hedayati E Eini MR Zali F Azizi Background: We studied the effects of serum iron level, hepatic iron deposition and other metabolic disorders i.e., insulin resistance in hepatic fibrosis development. Materials and methods: Among 60 patients with chronic hepatitis C, we measured serum iron, ferritin and transferrin level. Meanwhile, hepatic biopsies were obtained from 43 patients for whom iron deposition, inflammatory necrosis/fibrosis score and steatosis were determined. Results: Hepatic iron deposition was significantly associated with waist circumference, ferritin level >200ng/ml, fasting C-peptide >1.9ng/ml, AST/ALT ratio >1, and fasting triglyceride >200mg/dl. On the other hand, it was not correlated with the following: grading, preportal-precital hepatitis (A), necrosis (b), focal lytic necrosis (C), focal apoptosis (C), and portal inflammation (D). Conclusion: Our findings suggested an interaction between hepatic iron deposition and waist circumference, ferritin, fasting C-peptide, AST/ALT, and fasting triglyceride.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Comparison of blood culture with Acridine Orange stained 155 158 FA P Ayazi MM Daneshi F Babaiy HJ Hashemi M Barikbin Background: Different methods, with varying degrees of specificity and/or sensitivity, are used for diagnosis of sepsis. The present study was designed to determine and compare the sensitivity and specificity of blood culture with Acridine Orange (A.O.) stained smear of buffy coat in patients with sepsis. Material and methods: This research was conducted on 101 hospitalized patients with clinical signs and symptoms compatible with sepsis. Blood cultures were taken and A.O. staining was done on blood samples of all patients. Results: Blood cultures were positive in 20 (19.8%) patients. Sensitivity and specificity of blood cultures were 26% and 92% respectively. A.O. stained smears of buffy coats were positive in 54 (54.5%) patients. Sensitivity and specificity of A.O. Stained smears of buffy coats were 83% and 100% respectively. Conclusion: A.O. stained smear of buffy coat, as a diagnostic test of sepsis is more sensitive than blood culture. In addition, it takes less than one hour to be performed, as compared to blood cultures that give results in 2-3 days.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Nurses' perspectives on quality of nursing care: a qualitative study 155 158 FA M Pazargadi M Zagheri Tafreshi Zh Abed Saeedi Background: Optimizing the quality of health care is essential for delivery of effective, efficient and cost-benefit professional health services to people and communities. As nurses are the largest groups among health care professionals and are legally liable and morally responsible for their care, so their perspectives on quality of nursing care is very important. The purpose of this qualitative study was to define and describe “quality of nursing care” from the perspective of nurse experts and clinical nurses. Materials and methods: In this qualitative study, data were collected in two phases (10 individual interviews and 5 focus group discussions). Fifty-four nurses and experts participated by purposeful sampling. Data analysis was conducted by latent content analysis to achieve a definition of nursing care quality. Results: After taking into consideration different statements from experts in nursing and clinical nurses' perspectives on quality, we arrived at the final definition of optimal health care: "delivery of safe care based on nursing standards which eventuates client satisfaction". Also, both participating groups emphasized on collaborating with social workers in health care (teamwork). Conclusion: Findings revealed that in nurses' perspectives on quality definition, two important aspects that have been taken into consideration were: "standard of care" and "client satisfaction". Also coordinating organizational and socio-cultural workers in delivering quality nursing care was deemed to be important.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Bacterial contamination of eye cosmetics before and after use in Iran 159 162 FA K Ghazvini H Safdari Background: The possibility that cosmetic products may act as vehicles for pathogen transfer is a major health concern. The risk of this occurring is higher with cosmetics used around eyes, which could be responsible for a number of infectious diseases. This study was performed to evaluate the bacteriological quality of these products in Iran and also to study factors that predispose to bacterial contamination. Materials and methods: We examined a total of 290 samples, including 145 eye mascara lashes and 145 eye marker, for bacterial contamination. The products were then used by volunteers under actual in-use conditions for 4 weeks. Before, during and after use, the products were evaluated for microbial contamination by using standard methods for identification. Results: More than 14.5% of the unused eye mascara were contaminated while about 2.7% of eye markers showed contamination before use. Bacillus spp. and coagulase negative staphylococci were the most commonly recovered bacteria. Contaminations of in-use samples were significantly higher than unused samples. Conclusion: Contamination was relatively common and presents a potential health hazard. The high level of microbial contamination among unused samples emphasizes quality control during manufacture, packing, and preservation.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Dermatologic manifestations of patients on chronic 163 167 FA M Rahmati Roodsari F Malekzad R Shobeiri Background: Dermatologic diseases are common in patient with chronic renal failure, (CRF), being managed with hemodialysis. This study was done to determine the different patterns of skin involvement in these patients. Materials and methods: We examined 215 patients on hemodialysis in four hemodialysis centers in Tehran in 2006. Results: Of 215 patients, (122 men and 93 women), with the mean age of 56.4±16.2 years (range, 17 to 86 years), 202 (94%) had at least one type of dermatologic disease. They had been on dialysis from at least 1 year to 27 years. The most common dermatologic disease was xerosis, (59.1%). There was a significant relation between the patients’ age and solar elastosis (P=0.01), splinter hemorrhage (P=0.018), and longitudinal ridging (P=0.01). Also, the relationship between the duration of hemodialysis and yellow discoloration, xerosis, and koilonychia were statistically significant, (P=0.047, 0.019, and 0.01, respectively). A significant association was found between the patients’ job and folicullitis (p= 0.01), and between the underlying disease resulting in CRF and folliculitis or furunculosis (P= 0.039). Conclusion: As dermatologic diseases are very common in patients with chronic renal failure, referral to a dermatologist for optimal management will improve the quality of life in these patients.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Role of Intense Pulsed Light (IPL) in the rejuvenation of photo-aged skin 169 175 FA F Ghalamkar Z Ghorchiani Background: Photo-damaged skin is characterized not only by wrinkles and creases but also by epidermal and dermal atrophy, rough skin texture, irregular pigmentation, talengiectasis , laxity and enlarged pores. There is growing interest in the development of noninvasive methods to treat photo-damaged skin. Intense Pulsed Light (IPL), a non-coherent, broadband, pulsed light source is effective in the treatment of vascular and pigmented lesions of the skin. This study evaluates the role of IPL in the rejuvenation of photo-aged skin. Materials and methods: Full face skin of 20 women was treated for photo-aging using IPL. Light emitted at the cut off filter of 560nm and energy emissions varying from 28-32 j/cm2 were utilized for 3 or 4 treatment sessions at intervals of 4 weeks. Patients and physicians evaluated rhythids, mottled pigmentation, and talengiectasis. Reviscometer & Mexameter devices were used to assess treatment results. Results: Two aspects of photo-damage including wrinkling and mottled pigmentation showed mild to moderate improvement in 25% and 20% of subjects respectively. Talengiectasis showed mild improvement in 5% of subjects. Twenty-five percent of subjects were satisfied with the overall result of their treatments. Conclusions: Non ablative skin remodeling using IPL is in its infancy. Results of this study showed that photo-rejuvenation by intense pulsed light is not an effective method of skin rejuvenation.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Biochemical mechanism of inflammation in colorectal cancer 177 186 FA F1 Fatemi A1 Dadkhah M2 Honardoost SM3 Ebrahimi M4 Hedayati Biological and chemical stimulators cause tissue injury. Many epidemiological studies imply that chronic stimulation of tissues leads to cancer. One of the most important type of chronic tissue stimulation criteria is increased activity of the metabolic pathway of arachidonic acid and production of biochemical intermediates. Cyclooxygenase pathway (COX) of arachidonic acid leads to production of a variety of prostaglandins and thromboxanes. These inflammatory agents exert their biological effects on different organs and initiate human cancers. Lately, a variety of synthetic and natural drugs have been discovered that suppress the production of these inflammatory agents and inhibit cancer promotion. One of the most popular drugs, are non-steroidal anti-inflammatory drugs, (NSAIDs). In this review, we discuss the role of these inflammatory agents in colorectal carcinogenesis and also their mechanism of inhibition.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 31 2 2007 9 1 Atypical Kawasaki a case report 187 187 FA F Naghdi Background: Kawasaki disease is a worldwide problem, however, it is more common among Asians. Since 1960, over 170000 cases have been reported. In a child with prolonged fever (>5 days) in association with mucocutaneous or laboratory symptoms of systemic inflammation Kawasaki disease should be suspected. Atypical Kawasaki does not manifest with a pathognomic picture, therefore, mortality rate is quite high. Patient: An 11-month neonate presented with high grade fever, diarrhea, nausea, and irritability. During the second week, thrombocytosis was developed, however, coronary artery was intact. A high clinical suspicious as well thrombocytosis and high ESR level lead to the diagnosis of atypical Kawasaki.: Atypical