Tehran University Medical Journal

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Background: The aim of the study is to evaluate correlation between hyperhomocysteinemia and oxidative stress with severity of atherosclerosis lesions.
Materials and Methods: The patients (52 males and 36 females) were selected from individuals with angiographically defined CAD admitted to the shahid Madani Hospital. Control groups were selected from sex and age matched apparently healthy individuals (15 Males and 24 Females). Serum Homocysteine levles were measured by ELISA method (Awareness stat fax-2100 Model). Total antionxidant capacity of samples was determined by Autoanalyzer (COBAS MIRA plus model) using Randox kits. The correlation between the measured parameters and extension of atherosclerotic lesions were calculated using statistical analysis in the both groups.
Results: The mean levels of Homocysteine in patients and control groups were 20.38 ± 10.22 μmol/l and 18.56 ± 9.47 μmol/L respectively and the differences were not significant (p> 0.05) . In the patient group the mean level of Antioxidant capacity was 1.34 ± 0.12 mmol/L. whereas that of control was 1.39 ± 0.12 mmol/L (p>0.05). Using statistical analysis no correlation was noticed between extension of atherosclerosis lesions٫ low total antioxidant capacity and high serum total homocysteine .
Conclusion: In this study no significant differences between levels of homocysteine and total antioxidant in patients and control groups and no marked relationship between studied parameters suggest, that hyperhomocysteinemia has no important role in progress of atherosclerosis lesions.

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Background and Aim: Today, work related stress has become a common and costly problem in work places that most of studies in the last 30 decades have engaged in this problem. Several reports indicate that the occupations such as nursing which have high psychological job demands and low decision latitude are very stressful. This stress can cause harmful physical and psychological effects on nurses’ health. On the other hand, job stress may result in high rates of injury, tardiness and absenteeism at work place and reduced productivity and organizational commitment leading to low quality of nursing care. Numerous studies suggested that learning new activities and skills such as communication skills is one of the best strategies against job stress .The purpose of this study was to test the effectiveness of communication Skills training in reducing work stress level among nursing personnel in rehabilitation centers.

Materials and Methods: The quasi- experimental design was conducted. A sample of 48 nursing personnel participated in the study. Subjects were randomly assigned to one of two experimental or control groups. Subjects in experimental group participated in a 7- hour’s workshop, all subjects were pre and post tested (one month later) for job stress and communication skills with the Karasek’s Job Content Questionnaire (JCQ) and communication skills test.

Results: Results revealed the following: (1) subjects in both groups after pretest were the middle level of stress and communication skills. (2) After training the experimental group scored higher on the rating of communication skills than control group and had successfully maintained their improvements for 4 weeks. (3) After training the experimental group showed lower level of stress than control group and had successfully maintained their improvements for 4 weeks.

Conclusion: As a result of this research communication skills training could reduce level of stress among nursing personnel, thus. It is recommended to apply communication skills training programs for nursing personnel working at rehabilitation centers in order to assist them to coping with their job stress and improve the quality of nursing care.

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Background and Aim: Adenoids and tonsils are active lymphoid organs and playing an important role against invading antigens of upper aero digestive tract in children. The purpose of this study is observing the changes in cellular and humoral immunity of children six months after adenotonsillectomy.

Materials and Methods: The study population consisted of 30 children (aged 4-10 years) with chronic adenotonsillar hypertrophy and 30 age- matched healthy children. In all children serum level of IgM and IgG, percentage of T lymphocytes (CD3) , T helper (CD4) , T (CD8) and B lymphocytes (CD20) were measured. These parameters were re-measured in patients 6 months after adenotonsillectomy.

Results: Before the operation, a reduction in percentage of T lymphocytes (CD3) , TCD4, TCD8 and B CD20 was seen compared with control group. This reduction was only significant in T lymphocytes (CD3) (P.Value=0.03). The serum IgM level was not different in two groups and IgG level was elevated in two groups but not significantly different. Six months after operation the percentage of lymphocytes T CD3+, TCD8+, TCD4+ and BCD20+ was increased and reached the control group. The IgG level was also significently decreased in patients after operation (P.Value=0.00).               

Conclusion: Our results indicate that cellular and humoral immunity decreases in children with chronic adenotonsillar hypertrophy preoperatively and increases to healthy children level, six months postoperatively. It means that chronic adenotosillar hypertrophy affects some parameters of cellular and humoral immunity and adenotonsillectomy by removing chronic stimulations reverses these changes without any negative effect on immune function of patients.

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Background and Aim: Measuring the outcome of chronic diseases such as multiple sclerosis is an important factor in assessment of disease impact on different dimensions of quality of life and in evaluation of therapeutic interventions. The aim of this study was to perform the cross-cultural adaptation of the MSIS-29 which is a MS-specific outcome measure for Iranian patients.

Materials and Methods: The Iranian adaptation process of the MSIS-29 included 5 steps. To evaluate psychometric properties of the translated version, the questionnaire was administered to a consecutive sample of 96 patients with clinically definite MS referred to our out-patient clinic. Test-retest reliability was assessed in a sub-sample consisted of 30 patients. These patients completed the questionnaire on two occasions separated by a 7-day interval. The Iranian version of the SF-36 was also administered to this sub-sample in order to evaluate the validity of translated MSIS-29.

 Results: Statistical analysis indicated that the Persian version of the MSIS-29 had high internal consistency (cronbach’s alpha coefficients > 0.70) and test-retest reliability (intra-class correlation coefficients >0.70) and a good validity.

Conclusion: The Persian version of the MSIS-29 is a reliable and valid instrument for measuring MS outcome in Iranian patients. It can be used in clinical trials and cross-sectional studies.

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Background and Aim: Helicobacter pylori is the etiologic agent of chronic –active gastritis, gastroduodenal ulcers in humans, and a co-factor in the occurrence of gastric cancer and mucosa-associated lymphoid tumors, Adhesion of H.pylori to the gastric mucosa is a critical and also initial step in the pathogenesis of the disease. Bacterial adhesion inhibitory agents provide a novel pharmacologic approach to the management of infectious diseases.    

Materials and Methods: 22 H. pylori strains, isolated from the antral biopsies of 49 patients with dyspepsia, gastritis, gastric ulcer, duodenal ulcer,…were assayed by ELISA (UPR)to investigate the diversity of attachment to 7 mamalian cell lines.

Results: The concentration of H.pylori and cell suspention ,the condition and temperature, can alter the attachment rate.Best bacterial concentration was equal to 1 Mc farland,and for cell suspension was 5*10 cells/ml.90 minutes in 37C incubation period result in maximum attachment. H.pylori can attach to all 7 cell lines, there are no significant differences between 22 H.pylori strains in attachment to cells. The attachment pattern of H.pylori to the cells showed significant reduction respectly from HepII, HeLa, SW742, AGS,HT29/219, HT29 to Caco-2.Maximum attachment were seen to HepII, HeLa and SW742 cells, and among these HepII was the best cells for this purpose.

Conclusion: Our studies suggest that Hep II, HeLa and SW742 cells could serve as a suitable in-vitro model for the study of H.pylori adhesions, attachment, inhibition of attachment and detachment assays and among these Hep II cell is prefer recommended.

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Background and Aim: With the introduction of long term subcutaneous administration of Deferoxamine there has been a decline in the morbidity and mortality of transfusion-dependent beta thalassemia patients. But parenteral iron chelation therapy is still a burden and a major reason for unsatisfactory compliance and places an additional psychological burden on the patients. There are some factors contributing to low compliance in these patients. To evaluate compliance to Deferoxamine and barriers of non adherence and assessment the prevalence of depression and it’s association with compliance.

Materials and Methods: 205 patients with major thalassemia in children medical center older than 6 years old were included. They were classified in 3 groups by compliance index (CI: No. of days of treatment per one month/No. of treatment days prescribed by physician). CI>75 % was considered good ,CI< 50-75%: moderate,CI<50%:weak and 3d group the patients without compliance. For assessment of depression: Beck Depression questionnaires were given to the patients older than 18 years old and Children Depression Inventories (CDI)“kovacs” were given to the rest

Results: Of 205 patients (110 females (54%) and 95 males (46%)), 13.3% were non compliant, 14% had poor compliance, 62.7% had good compliance. Females were more compliant than males (P=0.034). Compliance improved in older age groups meaningfully (P=0.037). There was negative association between compliance and serum ferritin level (P=0.02). 22% of children and 12% of Adults had severe depression according to the questionnaires. There was no association between compliance and depression. The most prevalent problem rgarding Desferal injection was local reactions in injection site (83%).

Conclusion: As oral chelation therapies are not used routinely, more investigations regarding the noncompliance must be considered and this method of chelation therapy must be encouraged. Compliance is a multifactorial problem, so the solution to which requires close interaction between the patient, the family and community.

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Background: Intra-rater agreement in observing and decision making in diagnosis of any disease is of great importance.This investigation is to observe and read ultrasound pictures of ovarian cysts and distinguish its category for any radiologist. Distinguishability is one of the related entities in this matter and radiologists&apos ability in correct diagnosis is of great concern. In this study, we evaluated radiologist’s distinguishability of ordered categories of ovarian cyst diseases (benign, borderline and malignant) in ultrasonography. To do this, we measured intra-rater agreement of radiologists by Weighted Kappa coefficient, and then by the help of “square scores association model” and “agreement plus square scores association model” we evaluated their distinguishability in diagnosis of the severity of the ovarian cyst’s diseases.

Methods: In this analytical cross-sectional study, two radiologists and three radiology residents assessed ultrasounds of 40 patients separately and independently in two periods (with the interval of one week). Patients selected from those who were referred to Mirza Koochak Khan Hospital in January 2005. Ultrasounds were performed by an expert radiologist and by a single apparatus.

Result: Data from radiologists was evaluated by “square scores association model” due to their superior results of distinguishability. Mean of Weighted Kappa coefficient was 0.81 and intra-rater agreement was 0.99 for our radiologists, but due to weaker results of our residents, we used “agreement plus square scores association model” for analyzing and mean of Weighted Kappa coefficient was 0.65 and intra-rater agreement was 0.97 for them.

Conclusion: Although radiologists had a better function than their residents, all of them showed appropriate distinguishability and intra-rater agreement in diagnosis and categorizing of the ovarian cyst’s disease. To distinguish benign category from borderline was more difficult than to distinguish malignant category from borderline and radiologists showed better results in this than their residents did.

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Background: coronary artery disease (CAD) is one of the most important causes of mortality around the world. The mortality rate in acute myocardial infarction is about 30%. CAD risk factors change with time and there are very few studies in this field in Iran. These changes may be due to bio-environmental conditions. In this study our objective was to track these changes during a ten years period.

Methods: This study was done in three general hospitals of Tehran University of medical sciences on patients with first acute myocardial infarction (AMI) in years 1371 and 1381. Demographic and specific data were obtained from patient data sheets. Comparison of means was done by t-test and prevalence of risk factors by chi-square test.

Results: Two hundred fifty eight patients in 1371 and 289 patients in 1381 were admitted to three university hospitals due to acute myocardial infarction for the first time. The mean age of women with AMI decreased 4 years (P=0.022). No significant change was seen in other coronary risk factors. We also observed a significant increase in prevalence of myocardial infarction in women with three risk factors (P=0.01).

Conclusion: We found no significant change in the age of male patients and in the CAD risk factors in 1371 and 1381. Mean age of occurrence of AMI in female shows a four-year decrease during this period. More studies are needed to find reasons for this change.

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Background: Pruritus is one of the most common problems in patients suffering chronic renal failure. Twenty five - 35% of predialysis patients and 60-80% of patients during dialysis complain pruritus. The exact pathophysiology of pruritus is unknown however, some possible interactive factors include: histamine release from mast cells and basophiles, uremic skin, cutaneous mast cells proliferation, adipose cells atrophy, electrolyte imbalance, and accumulation of bile acids. Since histamine is the main proposed mediator in pruritus, the goal of this study was to evaluate the role of antihistamines in controling of pruritus of patients with chronic renal failure. This study was done as a before - after study during one year period in dialysis department of Imam Khomeini hospital.

Methods: Thirty patients complied with inclusion criteria were entered in the study. Treatment strategy was: 2 weeks treatment with hydroxyzine 25 mg TDS, followed by one week wash-out period, then 2 weeks ketotifen therapy 1mg BID and finally two weeks treatment with chlorpheniramine 4mg BD following one week washout period after ketotifen therapy. Pruritus severity before and after each treatment period was evaluated with Pruritus Severity Score (PSS) chart.

Results: The mean PSS reduction by hydroxyzine, ketotifen and chlorpheniramine, were 33%, 4.5% and 20%, respectively.

Conclusion: PSS improvement with hydroxyzine and chlorpheniramine was statistically significant (p<0.001). However, ketotifen induced pruritus reduction was not considerably significant.

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Background: Injection drug use (IDU) in Iran is not rare and is one of the main factors in opioid overdose. The objective of this study was the qualitative assessment of overdose, related factors, and available interventions.

Methods: A qualitative method was employed. Six districts of Tehran with a population of 400,000 inhabitants were selected. The districts were different in socioeconomic characteristics, urban structures and prevalence of IDU and crime. A total of 81 key informants from different sectors and 154 injection drug users (IDUs) were selected by purposeful, opportunistic and snowball sampling, and interviewed individually or in groups. Ethnographic observations were done for studying the life situation of IDUs.

Results: In one district no cases of IDU were found. In other districts, overdose in IDUs was reported to be common. Heroin injection alone or in combination with other drugs was the main reported cause of overdose. Reportedly, wrong estimation of drug purity was the most important reason. Even in the districts with highest rate of IDU and overdose, most clinics and hospitals did not have enough facilities necessary for management of acute opioid overdose.

Conclusion: According to the high prevalence of overdose, provision of preventive education of drug users and their relatives and availability and accessibility of emergency services is highly recommended.

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Background: Umbilical cord blood gas analysis is a useful method for assessment of oxygenation and acid-base status in neonates. Severe fetal acidemia is associated with increased perinatal mortality and increased risk of subsequent impaired neurological development. Due to high percentage of C/S in our country and the effect of anesthetic medications on umbilical blood gases which can cause neonatal acidosis and hypoxemia, the study of umbilical cord blood gas in vaginal delivery versus cesarean section is mandatory.

Methods: In this cross-sectional study one hundred samples were taken from Mostafa Khomeini hospital in summer 2004. The samples were taken immediately of umbilical vein after clamping the umbilical cord and analyzed after 10 minutes. Cases were classified in to 3 groups: vaginal delivery (n=40), elective C/S under general anesthesia (n=35) and C/S under spinal anesthesia (n=25). Duration of anesthesia and its effect on blood gas and infants apgar were assessed.

Results: In the first group (vaginal delivery) mean blood gase parameters were pH=7.3064.73, pO2=25.246.87, HCO3=20.562.03, Apgar=8.820.38 and pCO2=41.826.57. In the second group (general anesthesia) mean blood gaze parameters were: pH=7.3044.73, pO2=38.7014.02, pCO2=43.265.87, HCO3=21.1113 and apgar score=8.170.7. In the third group (spinal anesthesia) mean blood gaze parameters were: pH=7.3014.50, pCO2=44.14.99, HCO3=21.382.15, pO2=26.625.5 and apgar=8.600.62. The apgar scores and pO2 demonstrated significant relationship with type of anesthesia. The apgar score was lower and pO2 was higher in C/S under general anesthesia compared with the other two groups. There was significant relationship between duration of anesthesia and umbilical pO With increasing duration of anesthesia, pO2 was reduced. Between the type of delivery and anesthesia duration with PH, pO2, pCO2 and HCO3 were not meaningful relationship (P<0.05).

Conclusion: There was no significant difference between type of delivery and umbilical blood gas parameters. Neonatal apgar score in NVD is higher than the other groups. With increasing duration of general anesthesia in C/S, umbilical po2 is reduced.

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Background: Human plasminogen is a plasma glycoprotein synthesized mainly in the liver. Conversion of plasminogen to plasmin by plasminogen activators is a key event in the fibrinolytic system. In this study, we investigated the effects of two anti-human plasminogen monoclonal antibodies, A1D12 and MC2B8 on Glu-plasminogen activation in presence of u-PA, t-PA and streptokinase.

Methods: Producing of Hybridoma antibodies was performed by fusion of spleen cells from BALB/C mice immunized with Glu-plasminogen and NS1 myeloma cells. Antibody binding to Human Glu-plasminogen was assessed using an ELISA assay. Activation of plasminogen was determined by measuring plasmin generation using the chromogenic substrate S-2251 and the effect of monoclonal antibodies, A1D12 and MC2B8 on plasminogen activation in solution was then evaluated. Initial rates and kinetic parameters of plasminogen activation in the presence of monoclonal antibodies were calculated. The effect of the monoclonal antibody MC2B8 on the rate of plasmin hydrolysis was measured. The effect of F(ab&apos)2 fragment of A1D12 on u-PA catalyzed-plasminogen activation also compared with the effect of the whole antibody in this reaction.

Results: ELISA assay showed that the antibodies reacted well with antigens. A1D12 increased the maximum velocity (Vmax) of plasminogen activation by each of the three plasminogen activators and MC2B8 decreased it. In all activation reactions, the KM value of plasminogen activation did not significantly change in the presence of antibody A1D12 whereas antibody MC2B8 increased the KM value of plasminogen activation by u-PA, fibrin monomer dependent t-PA and streptokinase. Monoclonal antibody MC2B8 had no significant effect on plasmin hydrolysis rate of synthetic substrate S-2251. Activation rate of plasminogen by u-PA in the lower concentration of F (ab)2 fragment of A1D12 was identical to activation in the presence of the whole antibody.

Conclusion: The binding of the A1D12 F(ab) region to Glu-plasminogen increases the catalytic efficiency of plasminogen activation by plasminogen activators. Therefore, it may be useful to apply clinically A1D12 for the therapy of thromboembolic events such as myocardial infarction by humanizing the F(ab) fragment of the A1D12 antibody. Inhibition pattern of antibody MC2B8 obey the mixed type of enzyme inhibition by binding the antibody probably at, or near, the cleavage site of Glu-plasminogen.

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Background: In the year 2003, an earthquake in Bam led to death and injury of many of the inhabitants. The aim of this study was to the changes in opioid drug use in the survivers eight months after the earthquake in comparison with the month before the quake and its related factors.

Methods: An epidemiologic survey was carried out on 779 survivors, selected by desert sampling from the Bam citizens in the age of 15 and over. Bivariate and multivariate Logestic regression analysis were done for examining the relationship between an increase in opioid use and various factors.

Results: An increase in opioid use was reported in 18.3 percent of men and 2.3 percent of women. Odds Ratio (OR) for increase in opioid use was 9.4 times more in men than in women (95% CI=4.9-18.0). In men, increase in opioid use was related with the history of opioid use during the month before earthquake (OR=5.6, 95% CI=2.4-13.1), age (OR in age group 30 to 44 was 4.7 times more than age below 30, with 95% CI from 1.8 to12.1), and PTSD (OR=3.7, 95% CI=1.5-9.2). In women, it was only related to the history of opioid use during the month before earthquake (OR=43.8, 95% CI=12.5-154.0).

Conclusion: The findings show that following disasters, especially in the areas or groups that drug use is common, an increase in the drug use might occur. In these situations provision of preventive and treatment interventions particularly for at risk population is necessary.

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Background: This prospective phase III study was designed to compare the activity of two combinations chemotherapy drugs in advanced gastric adenocarcinoma
Methods: In a double blinded clinical trial, From Jan. 2002 to Jan. 2005, ninety patients with advanced gastric adenocarcinoma were randomly assigned to 1) Cisplatin and continuous infusion of 5FU and Epirubicin (ECF), and 2) Cisplatin and continuous infusion of 5FU with Docetaxel (TCF). Reduction in tumor mass, overall survival (OS), time to progression (TTP), and safety were measured outcome.
Results: About 90% of patients had stage III or IV disease and the most common sites of tumor spread were peritoneal surfaces, liver and Paraaortic lymph nodes in either group. The objective clinical response rate (more than 50% decreases in tumor mass) was 38% and 43% in ECF and TCF group respectively. Global quality of life increased (p=0 002) and symptoms of pain and insomnia decreased after chemotherapy. Patients in TCF had more grade one or two skin reactions, neuropathy and diarrhea. Fourteen patients underwent surgery. Complete microscopic (R0) resection had done in two of ECF and six of TCF tumors (p=0.015). Two cases in TCF group showed complete pathologic response. Median TTP was nine months and 10 months in ECF and TCF group respectively. Median OS was 12 months in both groups.
Conclusion: Although there wasn’t statistically significant difference regarded to clinical response or survival between two groups, TCF showed more complete pathologic response.

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Background: Atrial fibrillation is the most common arrhythmia following CABG. This complication can cause palpitation, significant hemodynamic instability and thromboembolic events. This prospective randomized study evaluate prophylactic effects of propranolol low dose amiodarone and high dose amiodarone in patients candidate for CABG.
Methods: Three hundred consecutive patients undergoing elective CABG were randomly categorized into three groups (each group contains 100 patients). Patients in group1 (control group) received 10mg/TDS propranolol per oral (P.o), preoperatively. Patients in group 2 received 10mg propranolol TDS, P.o plus 350mg/24h amiodarone. Patients in group 3 received 10mg propranolol TDS P.o plus 1000mg/24h amiodarone 24 hours before operation.
Results: Atrial fibrillation occurred in 12 patients (12%) in group 1, four patients (4%) in group 2 and 10 patients (10%) (P=0.035) in group 3. AF occurred in 10.36% of men and 3.84% of women. There was no AF in off- pump groups and 9.73% in on-pump groups
Conclusion: This study suggested the combination of propranolol plus low dose amiodarone for post CABG atrial fibrillation prophylaxy.

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Background: Despite advances in medical science and modern technology, epilepsy remains as a stigmatized condition and negative public attitude toward epilepsy is a common phenomenon especially in developing countries such as Iran. It is the major factor causing serious social discrimination against people with epilepsy which in turn may be more devastating than the disorder itself. Thorough understanding of the knowledge and attitudes toward epilepsy is essential to modify these negative attitudes.
Methods: We conducted a face-to-face questionnaire interview survey in crowd locations of Tehran in August, 2004-April 2005. A total of 1079 persons all more than 15 years old were asked to fill the questionnaire.
Results: Eighty eight percent of respondents had heard about epilepsy before, 42.2% of them knew one person with epilepsy. However, out of responses about the causes of epilepsy, 52/4% said it was caused by brain damage, 26.4% said it was an inherited disease,, 14.3% said it was due to fever, 34.8% believed stress as the cause of it and1.1% said evil spirits was the cause. 56.9% considered pregnancy to be appropriate for epileptics. 94% believed children with epilepsy could go to school and have normal education.
Conclusion: According to this survey, public knowledge and attitudes about epilepsy in study population is not satisfactory. It is suggested that additional efforts must be made to increase the knowledge of the general population through education programs especially among school children.

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Background: A variable hematological value without clinical sign of sepsis or hematological disorder is often observed in newborns. The purpose of this study was to investigate hematological measurements in umbilical cord vein of newborns delivered spontaneously or by cesarean section.
Methods: We studied 150 pregnant women who delivered term normal infants. The patients were divided into two groups according to the route of delivery: vaginal (n=75) and cesarean section (n=75). Immediately after delivery, umbilical cord blood samples were collected. Any possible relationship between mode of delivery, gestational age, gravidity, parity, sex, weight of the new born infant, and the duration of different phase of labor with the hematological parameters was investigated.
Results: We observed a significant increase in all hematologic parameters including hemoglobin and hematocrit levels and WBC, platelet and RBC counts in newborns delivered spontaneously (p<0.001). The lymphocyte counts were similar in two groups. Male infants and newborns with higher gestational age showed a higher hemoglobin and hematocrit levels. Increased parity and gravidity correlated with a decrease in all hematological values of umbilical vein blood except of lymphocyte count (p<0.001). Prolonged duration of first and second stage was associated with higher mean leukocyte, neutrophil, platelet, hemoglobin and hematocrit values.
Conclusion: The mode of delivery, gestational age, parity, gravidity, sex and weight of newborn, and the duration of first and second stage of labor can influence on hematological parameters of umbilical cord blood.

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Background: Autosomal-dominant polycystic kidney disease (ADPKD), a common hereditary disease, is characterized by the progressive development and enlargement of multiple cysts in both kidneys, and typically resulting in end stage renal disease (ESRD) by the fifth decade of life. Post-transplant diabetes mellitus (PTDM), a common complication after transplantation with an incidence rate of 2.5-20%, is associated with poor graft and patient survival. In few studies, PTDM has been more frequent in ADPKD transplanted patients. In the present study, we investigated whether there is any association between PTDM and ADPKD in our patients.
Methods: In this prospective study, 140 non-diabetic and nonsmoker successfully transplanted patients (27 ADPKD and 113 non ADPKD patients) were enrolled during three years. Both groups were matched for age, sex, body mass index (BMI), duration of renal replacement therapy before transplantation and also immunosuppressive protocols after transplant. Post-transplant diabetes mellitus was defined as Clinical Practice Guidelines advocated by Canadian Diabetes Association. All patients were followed for 12 months.
Results: PTDM occurred in 11.1% of ADPKD patients and in 13.1% of control group which was statistically insignificant (P > 0.05). The development of PTDM in ADPKD group was not related to sex, age, and hypertension, duration of renal replacement therapy before transplantation, BMI and serum creatinine levels (P > 0.05).
Conclusion: Post-transplant diabetes mellitus appears not to be associated with autosomal-dominant polycystic kidney disease as an etiology of end stage renal disease.

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Background: Long term use of immunosuppressive therapy in transplant recipients in order to prevent acute and chronic rejection increases the long term risk of cancer. This study evaluates the incidence of different organs’ cancer after renal transplantation and immunosuppressive therapy.
Methods: This is a retrospective analysis of malignant tumors in renal graft recipients with more than one year graft survival. Patients were assessed according to their age, sex, diagnosis of cancer, immunosuppressive drugs, donors and period of dialysis before transplantation.
Results: Evaluating all existing files in selected private clinics in Isfahan 350 patients were reviewed and 289 of them had entrance criteria. A total of 186 men and 103 women (mean age: 42.17±13.09 years) were included. They were followed up over a mean period of 52.46±33.24 months. A total of six cases (2.1%) of cancer were diagnosed in six recipients: All patients with cancer were male with a mean age of 51.17±14.7 years (range: 26-68 years). Tumor presented at a mean time of 51 months (rang: 15-82 months) after transplantation. There were two patients with BCC, two patients with SCC and two patients with lymphoma. Two patients died of progressive malignant disease. Age, period of dialysis before transplantation, and using immunosuppressive and anti-rejection drugs had no significant impact on development of post transplant malignancy.
Conclusion: The frequency of tumors in these patients is lower than what reported by other centers, probably due to short period of follow up and low incidence of cancer in our general population. The risk of malignancy was 28 fold higher among transplant recipients than in general population. High risk of cancer in this group, confirms the necessity of routine examination for organ transplant recipients both before and after transplantation.

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Background: Major thalassemia is relatively common in Iran and in looking of their need to recurrent transfusion their high risk for acquisition of HCV is revealed. These patients also suffer form liver hemosiderosis that accelerate disease excursion to cirrhosis and hepatocellular carcinoma. In this study combined therapy with interferon and amantadin has been evaluated.
Methods: This prospective clinical trail has been done on thalasemic patients that had been contaminated by HCV and had laboratory signs of hepatitis. During years of 81-82, 26 patients admitted at Children Mmedical Center with major thalassemia and HCV hepatitis. Inclusion criteria were positive HCV-RNA, high ALT and histologic evidence of hepatitis in liver biopsy and exclusion criteria were history of incomplete treatment any contraindication of IFN or amantadin-emergence of drugs adverse reactions, to intending of these criteria 10 case of them had situation for treatment and follow-up.
Results: In 10 cases, treatment with IFN  - 2b in doses 3 mu for every square meter of body surface three times in week subcutaneously and cap. Amantadin in doses 100 mg po B.d for 6 months was done and after it, 8 cases were negative for HCV-RNA (8%) and in 6 patients, ALT turned to normal (60%) and in 2 other case ALT decrease to lower than 50% of pretreatment value. None of them showed drug adverse reactions and response to therapy was better in lower ages. No relation between response to therapy and liver hemosiderosis, inflammation and sexuality was found.
Conclusion: Combined therapy with IFN and Amantadin is effective in HCV treatment and for lower recurrence, treatment period longer than 24 wk, such as 48 wk is recommended