School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 9 12 FA

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 Association between TaqI and -629C/A polymorphisms in CETP gene with low level of HDL-C in Tehran 13 17 FA Daneshpour M, Hedayati M, Azizi F Background: The aim of this study was to examine whether the well established effect of the common TaqI polymorphism in CETP gene on HDL-C concentration could be explained by the recently identified -629A/C functional polymorphism in the promoter. Material and method: To examine the association between A allele and HDL-C level, 943 healthy subjects enrolled in TLGS study were selected, among whom 335 were selected with the lowest, medium and highest deciles of HDL cholesterol levels. We accounted for factors that are known to influence HDL cholesterol level, such as smoking, body mass index and blood pressure. We amplified a segment of the mentioned gene with PCR and then revealed the polymorphism with RFLP. Result: The allele A frequency was higher in subjects with increased level of HDL. HDL level showed a significant difference between different genotypes (p<0.001). Homozygotes for the C allele had lower HDLC levels (37±11mg/dl) than subjects carrying the A allele (45±16mg/ml) (p<0.001). The percentile of AA allele in high HDL-C groups is higher than low HDL-C groups (33.7 and 19.2%, respectively). Conclusion: We have demonstrated that -629A/C polymorphism at the CETP gene is correlated with HDL cholesterol level. Also there was an association between TaqI polymorphism and -629A/C polymorphism.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 Efficacy of combined Xeloda/Taxotere regimen in metastatic breast cancer 19 21 FA Rostami N, Esfahani F Background: Taxotere and Xeloda have been previously shown to be effective in metastatic breast cancer when prescribed as a single drug in addition, some studies have demonstrated their synergism in breast cancer. During the present study, we have used a combined Xeloda/Taxotere regimen in metastatic breast cancer patients who have never been on either drug. Materials and methods: Twelve breast cancer patients who have been on anthracycline regimen and had at least one measurable metastatic site were included. They were put on the following regimen: Taxotere 75mg/m2 for the first day and Xeloda 1000mg/m2 twice a day for 14 days. This protocol was repeated 3 times with 3 weeks interval between each phase. Metastatic sites were reevaluated following the course of therapy. Results: Of 12 patients, 4 have shown a complete response and 3 partial response. Myelosuppression was the most frequent drug side effect presenting in 5 patients. Conclusion: Combined regimen of Xeloda/Taxotere was found to be more effective than the single drug regimen. The side effects are acceptable.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 Response to chemoradiation in patients with squamous cell carcinoma of esophagus treated at Shohada-e-Tajrish hospital 23 26 FA Mofid B, Mirzaie HR, Houshiari M, Rakhsha A Background: Esophageal carcinoma is among the first ten common malignancies worldwide, with a high prevalence in Iran. Previously, surgery or radiotherapy were the only modalities of therapy however, due to unsatisfactory outcomes, other therapeutic approaches such as chemoradiation are now under assessment as the first line treatment. Preliminary results have shown reduced local recurrence and better survival. Materials and methods: It was a quasi experimental study. Patients with squamous cell carcinoma of esophagus who had the following criteria were enrolled: lack of previous therapy, no metastasis, performance status of 0-2, and normal liver, kidney and bone marrow function tests. Chemoradiation was carried out through one of the following regimens: 1- Cisplatin 40mg/m2/weekly + 50-60Gy radiation or, 2- Cisplatin 75mg/m2 for the first day + 5-FU 1000mg/m2 for the first 4 days of weeks 1, 5, 9, and 13 + 50Gy radiation. Following the therapy, biopsies of suspected lesions and CT scan of local lymph nodes were obtained to evaluate the response rate. Results: Of 39 patients with non-metastatic squamous cell carcinoma of esophagus who had been referred to our unit during a 5-year period (1998-2003), 30 met the inclusion criteria. The study population included 23 males and 7 females with a mean age of 65 years (35-77 years). Tumor location was as follows: upper third of esophagus in 6, middle third in 12, and lower third in 12 patients. Twenty-one patients were put on the first protocol and the remaining nine patients on the second regimen. There were 2 deaths, one due to fever and neutropenia, and the other of uncertain cause. Clinical response to therapy was reported in 23 (76.6%) patients. Conclusion: Chemoradiation showed a low complication rate and high efficacy. It can be safely recommended for inoperable patients. Further clinical trials are necessary before definite recommendations can be made.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 IVIG therapy in iso-immune hemolytic jaundice in full-term neonates 27 31 FA Rostami N, Gosili R Background: Previous studies have demonstrated the efficacy of intravenous immunoglobulin therapy (IVIG) in decreasing the severity of neonatal immune hemolytic jaundice, the need for exchange transfusion, duration of phototherapy and hospital stay. Materials and methods: A randomized clinical trial was conducted in Taleghani Hospital in Tehran, between April 2003 and May 2004. Eighty full term infants with ABO or RH incompatibility and hyperbilirubinemia within the first 24 hours of life, were randomly assigned in two equal groups of experiment and control. A single dose of IV immunoglobulin 1g/kg was administered to 40 neonates over 4-6 hours during the first 24 hours of life along with phototherapy. 40 neonates in the control group received phototherapy alone. All patients were closely evaluated with respect to their general status, severity of jaundice, need for transfusion, and IVIG complications. T test and chi-square were used for data analysis. Results: The IVIG–treated neonates had a smaller rise in their bilirubin levels, required significantly less phototherapy (91 hours vs. 141 hours, p=0.0001), a shorter duration of hospitalization, (p=0.0001), and fewer exchange transfusions, (p<0.05), than those in the control group. We found no IVIG-related side effects. Conclusion: IVIG administration in newborns with ABO or RH hemolytic jaundice reduces the need for exchange transfusion, duration of phototherapy and hospital stay. However, further studies are required to determine the optimal dose and the frequency of infusions.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 Epidemiology of dyspepsia in Nahavand, Iran 33 36 FA Aghazadeh R, Mohammad Alizadeh AH, Ansari Sh, Ranjbar M, Hosseinnejad Yazdi M, Honarkar Z, Baladast Background: The prevalence and demographic features of dyspepsia are unknown in Iran. Thus, the present study was conducted to determine the epidemiology of dyspepsia in Nahavand. Materials and methods: From 5 urban regions in Nahavand (with more than 61000 population), 1518 subjects (mean age ± standard deviation 36.4±9.7 years, 865 females) were recruited through a systematic random sampling. Patients were questioned about dyspeptic symptoms, presence of any chronic disease, frequently used medications, previous operations and cigarette smoking in the previous 12 months. Dyspepsia was defined as the presence of following symptoms pyrosis, upper abdominal pain, bloating, nausea, vomiting, or early satiety, and abdominal fullness, for at least one month during the previous six months. Data obtained through face-to-face interview was documented on structured questionnaires. The association between various demographic and lifestyle factors with dyspepsia was quantified by odds ratios (ORs) using logistic regression. Results: 358 subjects (23.6%) had dyspepsia. Abdominal fullness (n=165) and abdominal pain (175) were the most common symptoms. More than half (n=183, 55%) had symptoms suggestive of dysmotility-like dyspepsia mixed type dyspepsia was the next most common (n=126 38%). Dyspepsia was more prevalent in subjects exposed to tobacco smoke, but it was not associated with alcohol abuse. Use of nonsteroidal anti-inflammatory drugs (OR=1.92, 95%CI=1.49-2.49, p<0.001), current smoking (OR= 2.45, 95%CI=1.45-4.07, p<0.001), and lower education level (OR=1.73, 95%CI=1.21-2.47, p<0.001) were associated with dyspepsia. 258 subjects with dyspepsia (60.7%) had received treatment with H2 blockers or proton pump antagonists, 7.7% had undergone previous endoscopy. Conclusion: Dyspepsia is reported by almost one-third of the population in Nahavand. Sixty percent of these cases receive treatment however endoscopy is performed in a small number of patients.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 Comparing knowledge, attitude and practice of senior nursing students and graduates of Shahid Beheshti University of Medical Sciencess 37 43 FA Banaderakhshan H Mehrabi Y Yazdani Sh, Mortazavi F Saedi N Saedi N Background: Appropriate nursing care for patients illustrates the quality of nursing practice in the society. In this study the knowledge, attitude and practice of senior nursing students and graduates of Shahid Beheshti University of Medical Sciencess (SBMU) were compared. Materials and methods: 54 nurses with a 4-6 years experience of nursing in the medical or surgical wards were selected through goal oriented sampling. 54 senior nursing students were randomly selected. Initial data was gathered using 4 questionnaires dealing with: knowledge, attitude, practice, and patients' and head nurses' opinion about the participants. Results: Mean score (± standard deviation) of knowledge was 63.7±3.2 and 45.3±2.1 in nurses and students, respectively (p<0.005). Positive attitude was recorded in 52% of participants. Patient evaluation of nursing students and graduates did not differ in the two groups, but the head nurses gave higher scores to the graduates (56.2±4.0) than to the students (53.4±6.0) (p<0.002). Conclusion: Results revealed that both nursing students and graduates possess ample knowledge and most have a positive attitude. Patients were satisfied with the performance of both groups.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 Epidemiologic features of depression in non–insulin dependent diabetic patients in Semnan 45 49 FA Behnam B Ghorbani R Background: Depression is a disease with serious complications and a high disability rate. Diabetic patients are more commonly affected than the normal population blood sugar control and preventing the consequences of diabetes are more complex in depressed patients. Early diagnosis of depression has been shown to be associated with better blood sugar control and response rate. Materials and methods: This Cross sectional study was performed on 450 NIDDM patients seen at Fatemieh Hospital Diabetes Clinic in Semnan during an 8-month period. Beck inventory questionnaire for depression was used for data collection. Beck inventory is a depression screening test having 21 indicators 13 cognitive and 8 for physical symptoms. To analyze the data, the Beck test scores for each case were added. Scores of 0–9 were considered as "without depression", 10-18 "slight depression", 19–29 "moderate depression" and scores of 30-63 as "severe depression". Chi–square test and Spearman correlation coefficient were used for data analysis. Results: 322 patients (71.6%) suffered from depression (95%CI=67.4–75.8),(79.2% of females and 57.3% of males) 66.9% of patients had been diagnosed during the past 5 years, and 78.3% of those having had diabetes for more than 16 years had suffered from depression with different degrees of severity. There was a significant association between the severity of depression and gender (p=0.0001), age (p=0.0001) and duration of disease (p=0.023). Conclusion: Because of the high prevalence of depression in these patients, it is recommended to identify the cases of depression using Beck inventory in addition to routine treatment for controlling their blood sugar. Meanwhile, there should be special emphasis on encouraging self-care in diabetic patients. KEYWORDS: Depression, Non-insulin dependent diabetes, Beck inventory

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 51 60 FA

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 61 65 FA

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 Ghojevand N 67 69 FA Sharifian M Ghojevand N Conorenal syndrome or Saldino Mainzer is a rare hereditary disease characterized by cone-shaped epiphyses of the phalanges, retinitis pigmentosa and renal manifestations (nephropathy). Case report: Herein we report an eight years old girl with a collection of signs and symptoms compatible with conorenal syndrome. She first presented with dactylitis, dysuria, frequency, discolored urine and progressive generalized edema. Renal biopsy revealed tubular atrophy, interstitial fibrosis and thickening of the glomerular basement membrane. This constellation of signs and symptoms is compatible with conorenal syndrome.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 Malignant transformation of neurofibromatosis lesions in Von Recklinghausen Syndrome 70 77 FA Hajinasrollah E, Khoshkar A, Sharifi MM Rakhshan M Neurofibromatosis (Von Recklinghausen syndrome) is an autosomal dominant genetic disease caused by a mutation in the gene expressing neurofibromin. It is characterized by café-au-lait macules, axillary or inguinal freckling, multiple neurofibromas, and developmental delay. Malignant transformation or sarcomatosis may occur in as many as 1.5-15% of patients. Case report: We present a patient with Von Recklinghausen syndrome showing malignant transformation 20 years after the initial manifestations of the disease.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 Septic polyarthritis caused by Staphylococcus aureus 71 73 FA Eslami G, Mardaneh J, Fallah F, Goudarzi H Staphylococcus aureus-induced septic polyarthritis is a rare entity characterized by the involvement of multiple joints. IV drug abusers are at increased risk, and it could be fatal if prompt intervention is delayed. Case report: A 30–year old male addict, (IV drug abuser), was admitted in Loghman hospital with high fever (38.5ºC), pulmonary symptoms, (cough and suppurative sputum), and pain and swelling in knees, ankles and both wrist joints. Blood and synovial fluid cultures were taken and the diagnosis of staphylococcus aureus-induced septic polyarthritis was confirmed. He was treated with vancomycin, penicillin and cephazolin. Although septic polyarthritis is a rare life-threatening condition, it should be kept in mind in immunocompromised subjects and IV drug abusers. Complete recovery is feasible with prompt diagnosis and intervention. KEYWORDS: Septic polyarthritis, Staphylococcus aureus.

School of Medicine, Shahid Beheshti University of Medical Sciences Research in Medicine 1735-5311 29 1 2005 3 1 79 79 FA