1 2008-8892 Shahid Sadoughi University of Medical Sciences, Yazd 212 Heart Association of serum leptin level with obesity in children with acute lymphoblastic leukemia Zareifar S Shorafa S Haghpanah S Karamizadeh Z Adelian R 1 8 2015 5 3 116 124 19 08 2015 19 08 2015 Background Obesity is a medical problem in survivors of childhood acute lymphoblastic leukemia. Obesity is associated with many complications, so it is important to investigate the respective etiology. Leptin is a protein synthesized in the fatty tissue and is effective in the control of obesity. Survey of leptin in acute lymphoblastic leukemia (ALL) survivors could be helpful in controlling obesity. Materials and Methods In this prospective study, 53 pediatric patients diagnosed with ALL between 2006 and 2012 from Southern Iran, were enrolled. We examined body mass index (BMI) status and performed laboratory measuring tests including triglyceride, cholesterol, fasting blood sugar, leptin at diagnosis time and then every 6 months and in the last visit. Results patients. At the time of diagnosis, 5.66% were overweight or obese, whereas at the end of treatment, approximately 13 patients (24.53%) were overweight or obese. The median and interquartile range (IQR) for blood leptin level were significantly higher for obese patients than other patients (885, 1120 vs. 246, 494 pg/ml), (P=0.030). The median and IQR were also significantly higher in females than in males (861, 969 vs. 204, 267 pg/ml), (P=0.006). Conclusion Obesity is a complication of ALL treatment. It is associated with elevated blood leptin level. Hypothalamus leptin resistance in obese patients should be considered. In each visit, clinicians should weight and their patient’s BMI take into account.
213 Heart Years of Life Lost and Childhood and Adolescent Cancer Mortality in Yazd Province, Iran (2004-2009) Mirzadeh M Mirzaei M Mirzaei M ShogaeiFar H 1 8 2015 5 3 125 130 19 08 2015 19 08 2015 BackgroundThe Years of Life Lost (YLL) due to cancer can be a more illustrative index. to promote preventive and therapeutic services, this study aimed to investigate the childhood cancer mortality and its trend over the past few years in Yazd to provide planners with baseline data. Material and Method Data obtained from death registration system of the healthcare center were used to calculate the age-specific standardized mortality for 5-year age groups. To calculate the YLL, the standardized expected YLL method was used with a discount rate of 0.03 for health gain in the future, the age weight of 0.04 for different years of age, and a constant age weight correction factor of 0.165. The collected data were analyzed using the Epi 6 and Excel 2007. Results 28 patients in Yazd aged 0-19 die annually due to cancer (male/female ratio 1.34). Leukemia and CNS tumors were the most common causes of death.The crude cancer death rate is 8.48 in boys and 6.72 in girls per 100000. Premature cancer deaths have caused 3,436 YLL in boys and 2,561 YLL in girls (4.92% of total YLL in both sex) .The average death age did not have a significant relationship with sex, location of residence. Conclusion Childhood cancer mortality has had a decreasing trend. This study can help in the assessment of healthcare needs and improvement of the quality of healthcare services. It can also help in the design and prioritization of interventions to identify cancer risk factors which can facilitate early diagnosis. 214 Heart Comparison effect of Midazolam alone and Midazolam combined with Ketamine in bone marrow aspiration pain in children Mahmoudi Ne H 1 8 2015 5 3 131 137 22 08 2015 22 08 2015 Abstract Background This study aimed to compare sedative and analgesic effects of oral Midazolam and Ketamine on Bone Marrow aspiration (BMA) and Lumbar Puncture (LP). Material and Methods This study was a randomized clinical trial and was performed in Amirkola Hospital in north of Iran, Babol during 2011 and 2012 .The study population consisted of 40 patients who underwent the first time of diagnostic BMA for any reason, patients were divided randomly in two groups: Oral Midazolam and combined Oral Midazolam and Ketamine. Each group consisted of patients with age of 3-7 years and over 7 years .Two methods of pain status and soothing were evaluated through CAMFORT scale checklist based on MAGNUSON National Institutes of Health Medical Center. Statistical analyses were done by Spss v.19. Results In our study, 17(42.5%) and 23(57.5%) were female and male, respectively. 28(70%) patients were aged between 3 and 7 years and 13(30%) older than 7 years. The obtained findings revealed that the difference between Midazolam sedation and combination of Midazolam and Ketamine sedation was significant (P= 0.00). The sedation in older patients was more than young patients in combination of Midazolam and Ketamine group. (P= 0.22). Conclusion These findings showed that Ketamine and Midazolam combination had more efficacy than Midazolam alone for decreasing pain and sedation. 220 Heart Mothers’ Satisfaction Rate from Hospital Cares in Hematology- Oncology Ward Boroumand H Moshki M Khajavi A Hashemizadeh H 1 8 2015 5 3 138 144 24 08 2015 24 08 2015 Background Satisfaction evaluation is a good way to assess hospital conditions. In Health Care System, parentscan be also as children's main supporters, thus they may act as patient's viewpoints' representatives.This study aimed to evaluate mother’s satisfaction of hospital care in hematology – oncology ward in Dr Sheikh hospital. Materials and Methods A Cross-sectional descriptive analytic study was conducted using Pediatric Family Satisfaction (PFS) questionnaire and interviewing with 164 mothers duringMarchto February2013. The obtained data were analyzed using SPSS -16 software and descriptive statistics. Results The mean age of mothers and children was31.2±5.8, and 7.95 4/66 years.The children were 64 % male and 36 % femael. A large number of mothers (%56 (describedtheir satisfaction about medical care as moderate,(%70.7) reported their satisfaction about nursing care at very high level and(36.5 %) reported satisfaction about welfare services at high level(59%)and describe overall satisfaction at very high level . The totals mean of mothers’ satisfaction ratewas 121.8 ± 10.8. The mean of medical care, nursing care, welfare services was 2.9±34.1,4.6±50 and4.8± 32.9 respectively. Conclusion Overall satisfaction with medical, nursing and welfare staff was acceptable. For more satisfaction, it is widely recommended to improve veinipuncture by nurses, Physicians should inform parents about the tests results, and finally disturbance in ward with noise should be controled. 215 Heart Seroprevalence of Hepatitis B, Hepatitis C and Human Valizadeh N Noroozi M Hejazi S Nateghi Sh Hashemi A 1 8 2015 5 3 145 148 22 08 2015 22 08 2015 Abstract Background Thalassemia patients that are conventionally treated by a regular transfusion regimen are exposed to blood born viral infections.The aim of this study was to investigate the seroprevalence of hepatitis B virus (HBV), hepatitis C virus (HCV) , and human Immunodeficiency virus(HIV) among all multitransfused thalassemia patients in west north of Iran. Material and methods A retrospective study was conducted in February 2014, on 32 patients in Urmia, suffering from transfusion dependent thalassemia were admitted to Motahari and Emam Khomeini hospitals. Patients’ medical records were studied for HBs antigen and seropositivity for HCV, and HIV antibodies. Results Out of 32transfusion dependent thalassemia patients aged between 5-17years, 18 (56.25%) and14 (43.75%) were male and female, respectively. All of them were found seronegative for HBs antigen, HCV, and HIV antibodies. Conclusion It seems that screening of blood products is efficient in Urmia , capital of West Azarbaijan, Iran for prevention of blood born viral infections. 216 Heart Serological Study on Cytomegalovirus and Toxoplasma Gondii in Doosti M Vahedian-Ardakani HA Talebi A Akhavan-Ghalibaf M Najafi A Aminorroaya MM Yazdani Sh Shayestehpour M 1 8 2015 5 3 149 154 22 08 2015 22 08 2015 Background Beta-thalassemia patients receive blood products from blood transfusion centers repeatedly. Blood transfusion can transmit Cytomegalovirus (CMV) and Toxoplasma gondii. The aim of this study was serological evaluation of these two infectious agents in thalassemia patients. Materials and Methods In a cross-sectional study, the enzymelinked immunosorbent assay (ELISA) testing was performed to detect IgM and IgG antibodies against CMV and Toxoplasma gondii in 96 thalassemia patients (under 18 years) and 144 healthy people. Data were analyzed by SPSS software and Chi-square test. Results A significant difference was observed in CMVIgM antibody levels between test group and control group in women (p<0.05). The prevalence of CMV IgM, CMV IgG, Toxo-IgG, and Toxo IgM antibodies in thalassemia patients were 5.2%, 95.9%, 16%, and 0%, respectively. Conclusions: In all thalassemia patients, Cytomegalovirus IgG is higher than healthy people. In addition, CMV IgM antibodies are higher in female patients. Antibody screening (IgM) on blood products for detecting Cytomegalovirus is necessary, but for Toxoplasma gondii is not necessary in the Yazd transfusion center. Conclusion In all thalassemia patients, Cytomegalovirus IgG is higher than healthy people. In addition, CMV IgM antibodies are higher in female patients. Antibody screening (IgM) on blood products for detecting Cytomegalovirus is necessary, but for Toxoplasma gondii is not necessary in the Yazd transfusion center. 257 Heart Comparison of anti-D immunoglobulin and dexamethasone in chronic and persistent forms of pediatric immune thrombocytopenic purpura Farhangi Hamid Badiei Zahra Ghasemi Ali Hesari Sara Banihashem Abdollah 1 8 2015 5 3 149 156 03 09 2016 03 09 2016 Bakcground: The aim of ITP treatment is to prevent intracranial hemorrhage and increase the platelet count rapidly. This study was conducted with the objective of comparing the efficacy of anti-D immunoglobulin (Ig) with dexamethasone in treating childhood ITP. Materials and Methods: In this randomized prospective control trial, 20 ITP patients (Platelet count<20,000/µl) younger than 16 were selected from those who referred to Dr. Sheikh Children Training and Research Hospital in Mashhad, Iran From February 2013 to January 2014. Patients were divided into two groups according to the type of administered treatment: group A received intravenous dexamethasone 40 mg/m2/ daily for four days. Group B received a single dose of intravenous anti-D Ig 50 µg/kg. The resultant data were then evaluated using SPSS (version 11.5). Results: In this study, 20 patients [11 girls (55%) and 9 boys (45%)] with the mean age of 5.6±4 years were enrolled. From the total number, 13 (65%) were younger than 5 years old, 4 (20%) aged between 5 and 10, and 3 (15%) were older than 10. There was no significant difference between the two groups regarding sex and age. In both groups the most common symptom was cutaneous manifestations (purpura, ecchymoses) (63.6% vs. 36.4% p=0.325). At enrolment time, the mean disease duration was 28±21 months, ranging from 5 to 132 months. Out of 20 patients, 9 (45%) suffered from chronic ITP, and 11 (55%) were in persistent phase of the disease. No significant difference was observed between the two groups regarding the frequency of chronic and persistent cases (p=0.370). Similarly, the follow-up platelet count four months after the treatment showed no significant difference between the two groups (p=0.241). Conclusion: The findings of this study did not confirm the priority of dexamethasone over anti-D Ig. The hemolytic side effects of anti-D were negligible compared to dexamethasone. 217 Heart The roles of IL-2, IL-7, and IL15 Ligands in B Cells development Aliyari Z Alami F Mostafavi T Taiefi Nasrabadi H Soleimanirad J Nozad Charoudeh H 1 8 2015 5 3 155 160 22 08 2015 22 08 2015 Abstract Background B cells play an important role in the immune system due to production of the immunoglobulin and secreting several cytokines. It has been shown that B cells produced successfully in the presence of stem cell factor (SCF) and Flt3 ligand (Flt3L). IL2, IL7, and IL15 cytokines as -common family have an essential cytokines may support either synergistically or in an additive manner to B cell proliferative activity. Thus, the present study focused specifically on IL2, IL7, and IL15 cytokines that may play a critical role in B cell proliferation in cord blood. In this study, we evaluated the generation of B cells from CD34+/- cord blood mononuclear cells by using IL-2, IL- 7, and IL-15. Material and Methods Cord blood mononuclear cells were cultured for 21 days in presence of different combination of IL-2, IL-7, and IL-15. Harvested cells were analyzed by flow cytometry at days 0, 7, 14 and, 21. Results Present study showed that B cell differentiation from CD34+ cord blood mononuclear cells was increased by using IL-2 and IL-7 at different time points however, IL7 was more effective (P value < 0.0001). In contrast, IL-15 didn’t increase significantly B cell expansion from CD34+ cord blood mononuclear cell. Conclusion These findings showed that IL-2 and IL-7 significantly increased B cell generation from cord blood CD34+ cells probably this cytokines may be used in ex vivo generation of B cells from cord blood mononuclear cells. 259 Heart Effect of Sodium Bicarbonate and Sodium Chloride on Renal and Hematologic Factors in Patients with Glucose-6-phosphate Dehydrogenase Deficiency Mirbehbahani Narges Beigom SalamiKhanshan Aysan Safaian Baranak Mohammadian Sakineh behnampour Nasser Ariannejad Safa Masoomnia Ali Reza Malekmarzban Azin Rashidbaghan Azam 1 8 2015 5 3 157 165 03 09 2016 03 09 2016 Background: Sodium bicarbonate serum therapy is used for compensation bicarbonate lost and increasing blood pH in metabolic acidosis caused by severe anemia in patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency. The aim of present study was comparison the effect of serum therapy using two different serums (serum with bicarbonate and without bicarbonate) on some renal and hematologic factors and their side effects in patients with hemolysis caused by G6PD deficiency. Materials and Methods: In this clinical trial study, 79 patients with favism randomly put into two treatment groups, sodium bicarbonate and sodium chloride fluid therapy. During treatment, patients received blood based on hemoglobin (Hb). Duration of hospitalization, times of Blood transfusion, received blood volume, duration of cleaning UA of Hb, Hb, urine pH and granular casts in UA were evaluated. Results: The mean age of patients was 51.22 ± 37.86 months and there were 58 males and 21 females. Only duration of hospitalization and urine pH statistically showed a significant difference between two treatment groups (P=0.036 and P> 0.01, respectively), and other factors were statistically almost identical. Conclusion: The efficiency of sodium chloride was more than sodium bicarbonate in reducing the duration of hospitalization and the small clinical difference between received blood volumes, hemoglobin changes and duration of removing hemoglobin in UA, suggest, properly, sodium chloride can be more effective on improvement of hemolysis. Lack of side effects such as metabolic acidosis, heart damage and kidney failure in children can be due to controlled injection method, the concentration of soluble drugs and small size of studied population.  218 Heart The Iran thalassemia prevention program: success or failure? Hashemieh M Timori Naghadeh H Tabrizi Namini M Neamatzadeh H Hadipour Dehshal M 1 8 2015 5 3 161 166 22 08 2015 22 08 2015 Abstract Background Iran is one of the countries located on the “thalassemia belt” and a thalassemia prevention program was approved in our country in 1995. Many different researchers have studied the success of this program with no unanimous findings. Material and Methods A comprehensive literature search was performed using PubMed, Web of Science, and Google Scholar databases in Farsi and English languages for relevant articles published up to March 2015. Results A total of 46 articles regarding thalassemia prevention were identified. After screening the titles and abstracts, 27 articles were excluded because they were the same articles, review articles, and case reports. Finally, 16 articles about the success of the Iranian thalassemia prevention program were selected for the evaluation. Conclusion The findings show that the program has been significantly successful in the reduction of the new thalassemia births, though not in a few provinces like Sistan and Baluchestan. The role of the network of genetic labs has been also indispensable in the reduction of the new births. However, there is ambiguity over the impact of the program on the attitude and awareness of people across the country about the prevention of inherited diseases. However, with the success of the Iran thalassemia prevention program, it needs to be modified to be more compatible with the relevant social textures of different provinces. 219 Heart Solid Pseudo-Papillary Tumor of the Pancreas in a 10 year old girl Goudarzipour K Jenabzadeh A Mirzaei Ilali H Behnam B Tavassol H 1 8 2015 5 3 167 169 22 08 2015 22 08 2015 Abstract Background Solid pseudo-papillary tumor of the pancreas (SPTP) is a rare disease with a low malignant potential. Though it shows low malignant potential 10% to 15% of the cases show aggressive behavior with metastatic involvement of the liver. The symptoms include abdominal discomfort and abdominal pain. It is very rare in early years of age. This is the case of a 10 year old girl with abdominal pain and her evaluation revealed solid pseudo-papillary tumor of pancreas. In family history, her grandmother died because of pancreas cancer. The mass was excised and in her 6-month follow up she didn’t have any problems. This case is presented to point out physicians that more attention to pseudo- papillary tumor can bring us significant improvement in the diagnosis of this pathology, though pseudo- papillary tumor is a rare pathologic condition in children. 261 Heart Gene Expression and Promoter Methylation Status of VHL, Runx-3, E-cadherin, P15 and P16 Genes During EPO-Mediated Erythroid Differentiation of CD34+ Hematopoietic Stem Cells Eskandari Fatemeh Pourkarim Hoda Pakpour Amir H Goudarzi Mehdi Mobarra Naser Sahmani Mehdi Dehghanifard Ali Kalantari Nasim Gholamreza Khamisipour Azad Mehdi 1 8 2015 5 3 172 181 03 09 2016 03 09 2016 Background: VHL (von Hippel-Lindau), Runx-3 (Runt-related transcription factor 3), E-cadherin (Epithelial cadherin), P15 (INK4a, cyclin dependent kinase inhibitor), and P16 (INK4b) genes are essential in hematopoiesis. The aim of this study was to explore the correlation between gene expression and promoter methylation in CD34+ stem cells before and after differentiation to erythroid lineage. Materials and Methods: CD34+ hematopoietic stem cells were separated from umbilical cord blood using MidiMacs (positive selection) system. Expanded CD34+ stem cells were differentiated into erythroid lineage with human recombinant erythropoietin (EPO). DNA extraction was done by QIAamp DNA Mini Kit. RNA was extracted using RNase Mini plus Kit. MSP (Methylation specific PCR) technique was done for methylation assay. Methylation status and expression assay was done for VHL, Runx-3, E-cadherin, P15, and P16 genes  on both CD34+ stem cells and differentiated erythroid cells. Results: The results showed that, before differentiation, P15 had comparative methylation pattern and average expression and it remained unchanged after differentiation (p=0.01). concerning P16, results revealed no methylation pattern and complete expression in absence of EPO and with EPO it changed to comparative status (p=0.01). E-cad and Runx-3 genes had relative methylation pattern and fully expression before and after differentiation but their expression after that, was increased and decreased  Respectively (p=0.04). VHL gene had no significant methylation status before or after differentiation and its expression was complete (p=0.01). Conclusion: The obtained results indicated that promoter methylation of P15, P16, VHL, Runx3 and E-cad was one of the definitive expression control mechanism of these genes.