Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 8 2013 08 15 513 519 EN Hamed Montazeri Department of Molecular Biology, Pasteur Institute of Iran, Tehran, Iran. Saeid Bouzari Department of Molecular Biology, Pasteur Institute of Iran, Tehran, Iran. Kayhan Azadmanesh Department of Virology, Pasteur Institute of Iran, Tehran, Iran. Seyed Nasser Ostad Department of Toxicology Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Hossein Ghahremani Department of Toxicology-Pharmacology, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Molecular Medicine, School of Advanced Technology in Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Cyclin E, HER-2 and p53, are considered as major prognostic markers in breast cancer. As they are related in patho-clinical level, we aimed to check if they have any direct interaction on expression of each other. To study the effect of cyclin E on HER-2 expression, cell lines stably overexpressing cyclin E or its low molecular weight (LMW) isoforms were generated. To understand the results of p53 silencing either alone or in combination with cyclin E overexpression, we created three different p53 stably knocked down cell lines. Protein expression was analyzed by western blot, HER-2 expression in the established cell lines were determined using SYBR green real time PCR and data analyzed by REST software. Results indicate that HER-2 expression is only downregulated following p53 silencing and none of cyclin E isoforms can alter its expression. The presence of cyclin E isoforms in p53 silenced clones also does not altered HER-2 expression. Given the fact that p53 degradation is increased by HER-2 overexpression, these data can draw a regulatory loop in which a non-mutated functional p53 and HER-2 can bidirectionally regulate the expression of these two genes. This study improves our understandings of these pathways and these proteins can be introduced either as a marker or as a target in cancer treatment. https://acta.tums.ac.ir/index.php/acta/article/view/4400 https://acta.tums.ac.ir/index.php/acta/article/download/4400/4259

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 8 2013 08 15 520 524 EN Alireza Fahim Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran. Bijan Rezvan Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran. Hassan Hashemi Noor Ophthalmology Research Center, Noor Eye Hospital, Tehran, Iran. AND Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 This study aimed to assess changes in contrast sensitivity and aberrations in cases of myopia greater than 5.0 diopter (D) who had photorefractive keratectomy (PRK). In this semi-experimental study, 20 eyes of ten patients were studied. Inclusion criteria were at least 5.0 D of myopia, stable refraction in the past year, no history of refractive surgery, a minimum corneal thickness of 480 μm, and having surgery in both eyes. Exclusion criteria were the presence of any corneal condition. In addition to the routine tests, aberrometry and assessment of contrast sensitivity was done using the WaveLight Allegro Analyzer and the VectorVision CSV-1000. After PRK using the Concerto Excimer Laser (WaveLight, Alcon), patients were scheduled to have follow-up visits at 1 month, 3 months, and 1 year after surgery. Contrast sensitivity with glare showed an increasing trend only at the spatial frequency of 3 cycles per degree (cpd) (P=0.013). Contrast sensitivity without glared increased postoperatively at special frequencies of 3, 6, and 18 cpd (P<0.05). The preoperative level of higher order aberrations root mean square (HOA RMS) of 0.24±0.08 reached 0.71±0.25 at 12 months after surgery. Assessment of comma and trefoil showed no significant difference between preoperative and postoperative values, but the amount of spherical aberration changed from a mean preoperative value of 0.0±0.09 to 0.27±0.15 at 12 months after surgery. In the treatment of myopia greater than 5.0 D, PRK with the Concerto Excimer Laser can improve contrast sensitivity in certain spatial frequencies. This is while HOA RMS and spherical aberration increase. https://acta.tums.ac.ir/index.php/acta/article/view/4399 https://acta.tums.ac.ir/index.php/acta/article/download/4399/4261

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 8 2013 08 15 525 529 EN Ebrahim Razmpa Department of Otolaryngology, Tehran University of Medical Sciences, Tehran, Iran. Babak Saedi Department of Otolaryngology, Tehran University of Medical Sciences, Tehran, Iran. Amin Dostee Department of Otolaryngology, Tehran University of Medical Sciences, Tehran, Iran. Mohsen Ordobadee Department of Otolaryngology, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Chronic rhinosinusitis (CRS) is a common disease which is usually diagnosed clinically, considering the combination of natural history, physical examination and imaging studies. This study aimed to evaluate the clinical value of routine postoperative histopathologic examination (POHE) in patients with a clinical diagnosis of chronic rhinosinusitis with polyposis (CRSWP), or without polyposis (CRSWOP One hundred of patients with clinically approved CRSWP and CRSWOP were enrolled in this study. All patients underwent complete physical examination, scoring paranasal sinuses involvement by Lund-Mackay (LM) CT scoring scale, determining the extent of polyposis by Stumberger's endoscopic classification, and assessing health related quality of life by Sinonasal Test 22 (SNOT22) questionnaire. After FESS, histopathologic results were compared with preoperative clinical diagnosis. Among our patients, 65% were male, and the rest of them were female. Also, 66% of them suffered from CRSWP, and the rest of them were CRSWOP. LM CT score and SNOT22 score was 36.62±12, 17.11±6, and 43.62±20 respectively. Only in one of patients with CRSWP, POHE was other than what was expected preoperatively (adenoid cystic carcinoma). In all other cases,  POHE was well correlated with preoperative clinical diagnosis. HRQOL was better in males, absence of septal deviation and CRSWOP (P<0.05). Para nasal sinuses involvement in preoperative CT was more severe in the presence of eosinophil in POHE (P=0.008) and in patients with class 3 Stumberger's classification (P<0.001). This study suggested preoperative clinical diagnosis of CRS considering the combination of natural history, physical examination and imaging studies can be accurate, and POHE is indicated only in suspicious cases. https://acta.tums.ac.ir/index.php/acta/article/view/4398 https://acta.tums.ac.ir/index.php/acta/article/download/4398/4266

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 8 2013 08 15 530 536 EN Seyed Hadi Samimi Ardestani Department of Otolaryngology, Head and Neck surgery, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Hossein Dadgarnia Department of Otolaryngology, Head and Neck Surgery, Rhinology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mohammad Hossein Baradaranfar Department of Otolaryngology, Head and Neck Surgery, Rhinology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mona Mazidi Department of Otolaryngology, Head and Neck Surgery, Rhinology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mahtab Rabbani Department of Otolaryngology, Head and Neck Surgery, Rhinology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Nasim Behniafard Researcher of Rhinology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Amin Baradaranfar Student of Medical School, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Simple snoring is a social problem, one that can gravely affect the patient's married life. About 40% of men and 20% of women are affected, and it often goes along with sleep-disordered breathing. Up to now various surgical techniques have been defined such as UPPP(uvulopalatopharyngo plasty), and laser-assisted uvulopalatoplasty (LAUP). Among the surgical methods, RAUP (radiofrequency assisted uvulopalatoplasty) is a minimal invasive, an easy performed, and time and cost effective one. We designed a before and after a clinical trial. The inclusion criteria were age >18 years, complaint of nocturnal snoring, have a bed partner to assess snoring, AHI<5 events per hour in the polysomnography, malampathy score (soft palate position) I or II, an elongated uvula, grade I and II of pharyngeal webbing and patient consent was needed too. A 10-score visual analog scale (VAS) of snoring severity was completed by bed partner. All of 35 included patients underwent RAUP under local anesthesia by the same expert surgeon. After 3 months, 6 months and one year, subjective snoring decreased significantly compared to the preoperative period. The decline in VAS in 6 month compared to 3 months postoperatively, was not significant (P=0.223). When comparing 1 year and 6 months after treatment, the VAS scores were increased, but they were not significant (From 1.8 to 1.9, P=0.78). Three months after treatment minor complications consisted of: nasal regurgitation in 2 patients (5.7%), nasal speech in 2 (5.7%) and exacerbation of snoring in 2 (5.7%) patients.There was no major complication including mucosal laceration, uvular damage and obstruction of the airway. The rate of snoring decrease did not correlate with age, sex and BMI. Based on this study and literature review, it seems RAUP is a safe surgery, which may decrease symptoms of snoring, at least, in short-term follow-up. https://acta.tums.ac.ir/index.php/acta/article/view/4397 https://acta.tums.ac.ir/index.php/acta/article/download/4397/4272

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 8 2013 08 15 537 542 EN Mehdi Sanatkar Department of Anesthesiology, Razi Hospital, AND Department of Anesthesiology, Farabi Hospital, Tehran University of Medical Sciences,Tehran, Iran. AND Department of Anesthesiology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Sadeghi Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Nafiseh Esmaeili Autoimmune Bullous Disease Research Center, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Hassan Naseri Department of Cardiac Surgery, Baqiyatallah University of Medical Sciences, Tehran, Iran. Hossein Sadrossadat Department of Anesthesiology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mehrdad Shoroughi Department of Anesthesiology, Farabi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hamid Reza Fathi Department of Plastic Surgery, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shahrokh Ghazizadeh Department of Plastic Surgery, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 The use of local anesthesia with lidocaine containing epinephrine in patients with cardiac disease is controversial in the literature. The aim of our study was determining the safety of use the local anesthesia contain epinephrine in patients with ischemic heart disease that undergoing reconstructive surgery. Thirty two patients that had known ischemic heart disease and candidate to undergo reconstructive surgery for skin tumor enrolled in this study.  All patients continued their medication for cardiac disease till morning of the operation. 10 ml lidocaine 2% containing 1:100,000 epinephrine was injected in patients for local anesthesia. The hemodynamic changes and electrocardiographic variables before injection were compared with them after injection, during surgery and till 6 hours postoperation period. A 12 lead electrocardiogram was recorded in all our cases for detection of myocardial ischemic changes. The mean age, weight and height were 58.2±10.4, 74.8.±14.4 kg and 164.5± 8 cm respectively. Twelve patients (37.5%) were diagnosed with systemic hypertension and 10 patients with diabetes (31.2%). The comparison of change of systolic, diastolic and mean blood pressure between baseline, during procedure and after operation defined that our subjects did not have any significant disturbance in blood pressure in perioperative period. The comparison of baseline heart rate with heart rate after injection, during procedure and in postoperation period indicated a significant changes in this variable (P=0.044). The heart rhythm during the perioperative period also failed to exhibit alterations. The ischemic change was not recorded in our patients before injection compared to after injection. None of our patients have any early complications because of infiltration of local anesthetic containing epinephrine in our patients. The use of 10 ml 2% lidocaine with epinephrine 1:100,000 in patients with cardiac disease represent a safe anesthetic procedure. These patients experienced a more profound anesthesia with hemodynamic stability and without myocardial ischemic changes. https://acta.tums.ac.ir/index.php/acta/article/view/4396 https://acta.tums.ac.ir/index.php/acta/article/download/4396/4274

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 51 8 2013 08 15 543 547 EN Homayoon Bashiri Department of Internal Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 11 Over the past three decades physicians have used light level laser therapy (LLLT) for the management and the treatment of diabetic peripheral neuropathy and have obtained results that calls for further investigations. This study aimed to investigate the effectiveness of LLLT in treatment of pain symptoms in patients with diabetic polyneuropathy. In this study 60 patients with diabetic peripheral neuropathy were matched based on their sex, age, BMI, type of diabetes, duration of diabetes, and duration of pain, and randomized to case and control groups based on their established scores on the visual analog scale (VAS) and the Toronto clinical scoring system (TCSS). Cases received laser therapy with wavelength of 78 nm and 2.5 j/cm2 two times a week, each time for 5 min, for one month. During the same period, controls received sham laser therapy. Comparing the differences between the two groups' VAS and TCSS mean scores before the intervention with that of the 2 weeks and 4 weeks after the intervention we were able to see a statistically significant difference between the two groups (P<0.05). On the other hand, when we compared their VAS and TCSS mean scores 4 weeks and 2 weeks after the intervention we did not find any statistically significant difference between the two groups. We achieved the same results when we examined cases' and controls' pre and post VAS and TCSS scores independent from each other; no improvement in the assessment based on their 2 and 4 weeks comparisons tests. Laser therapy resulted in improved neuropathy outcomes in diabetic patients who received it relative to the group that received sham therapy, evaluating before and after LLLT assessments. Further studies are needed to test types of lasers, as well as different dosage and exposure levels required in different phase of neuropathic care, so as to obtain reproducible results. https://acta.tums.ac.ir/index.php/acta/article/view/4395 https://acta.tums.ac.ir/index.php/acta/article/download/4395/4279

Tehran University of Medical Sciences https://acta.tums.ac.ir/index.php/acta/article/view/4539 https://acta.tums.ac.ir/index.php/acta/article/download/4539/4657

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 11 2014 11 15 831 836 EN Setila Dalili Department of Pediatric Center, Pediatric Growth Disorder Research Center, Guilan University of Medical Sciences, Guilan, Iran. AND Departments of Health Center, School of Health, Guilan University of Medical Sciences, Guilan, Iran. Seyed Mahmood Rezvani Departments of Health Center, School of Health, Guilan University of Medical Sciences, Guilan, Iran. Hossein Dalili Departments of Pediatrics, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Zahra Mohtasham Amiri Department of Social and Preventive Medicine, School of Medicine, Guilan University of Medical Sciences, Guilan, Iran. Hamid Mohammadi Departments of Pediatrics, Pediatric Growth Disorder Research Center, Shiraz University of Medical Sciences, International Branch, Fars, Iran. Abdolreza Medghalchi Department of Ophthalmology, Eye Research Center, Guilan University of Medical Sciences, Guilan, Iran. Mohamad Hossein Novin Departments of Health Center, School of Health, Guilan University of Medical Sciences, Guilan, Iran. Hajar Gholamnezhad Departments of Health Center, School of Health, Guilan University of Medical Sciences, Guilan, Iran. 2015 10 11 Rising obesity incidence and its complications have lead to change of our view about cardio-metabolic risk factors and need of reassessment of these complications in childhood age. The aim of current study was to evaluate prevalence of obesity and related cardio-metabolic risk factors of children. This was a cross-sectional study in a representative sample of 12 years old children in Rasht, the biggest city in north of Iran. Participants were interviewed and examined by a trained research team and demographic characteristics, detailed examination (height - weight - blood pressure) were recorded. Blood samples were drawn for biochemical testing including Fasting blood sugar, Triglyceride, Cholesterol, HDL & LDL. Data analysis was done using SPSS software. Total participants were 858 children and 550(64%) were male. Prevalence of underweight, normal weight, overweight, obese were 22.5%, 54.4%, 11.3%, 11.8%, respectively. The prevalence of cardio-metabolic risk factors included hypercholesterolemia (6.7%), hypertriglyceridemia (33.6%), high LDL (5.9%), low HDL (28 %), high systolic (7.6%) & diastolic blood pressure (10.6%) (> percentile) and abnormal carbohydrate metabolism (12%) revealed hypertriglyceridemia as the most common dyslipidemia. Correlation analysis didn't show significant correlation between BMI & FBS but LDL, Cholesterol and TG had week positive correlation with BMI (Pearson correlation: 0.161, 0.285, 0.222 respectively, p value <0.001). Obesity and dyslipidemia are common problems in this area and we should note to screen cardiometabolic risk factors in addition of obesity, especially in children with rapid weight gain. This study highly recommended more investigation to evaluate final effect of these factors in adulthood. https://acta.tums.ac.ir/index.php/acta/article/view/4538 https://acta.tums.ac.ir/index.php/acta/article/download/4538/4658

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 11 2014 11 15 837 843 EN Abbas Norouzi Javidan Brain and Spinal Cord Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran. Fedyeh Haghollahi Vali-E-asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Ramezanzadeh Vali-E-asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mir Saeed Yekaninejad Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Zohre Amiri Department of Basic Science, School of Nutrition and Food Technology, Shahid Beheshti University of Medical Science, Tehran, Iran. Mansoreh Noroozi Vali-E-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran. Fatemeh Sadat Hosseini Vali-E-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran. Elham Azimi Nekoo Vali-E-Asr Reproductive Health Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Marvelon®, a combined oral contraceptive, contains 30 μg ethinyl estradiol (EE) and 150 μg desogestrel (DE), and has been shown to be a well-tolerated and effective combination that provides high contraceptive reliability and good cycle control. However, its efficacy has not been yet evaluated among Iranian women. Thus, the study aimed to determine the effect of oral contraceptive pill on treating premenstrual symptoms and on various parameters associated with well-being and health in a sample of Iranian. This clinical trial (before- after) study was performed at the family-planning clinic of the centers under the supervision of Tehran University of Medical Sciences on sixty-one women. The study protocol was approved by the Ethics Committee of Tehran University of Medical Sciences and all participants received a 21/7-day regimen of oral contraceptive containing 150 μg desogestrel (DE) and 30 μg ethinyl estradiol (EE) for six cycles. Efficacy parameters included changes in premenstrual symptoms were also assessed. Clinical data was collected by calendar of premenstrual experiences (COPE) at baseline and treatment cycles 1,2, 3 and 6. Clinical variables were measured including low-density lipoprotein (LDL), high-density lipoprotein (HDL) and triglyceride levels for two timing periods (baseline and last visit). Linear mixed model analyses were used to analyze differences in changes of the four factors of premenstrual syndrome (PMS), weight and blood pressure during these timing periods. The mean age of the women was 28.52 (SD=6.75) years. Participants on average had been pregnant 1.13 (SD=1.16) times. The linear mixed model analyses indicated that premenstrual syndrome symptoms reduced significantly over time (P0.05). A combined oral contraceptive containing ethinyl estradiol and desogestrel has a positive effect on women's health and reduces premenstrual symptoms. https://acta.tums.ac.ir/index.php/acta/article/view/4537 https://acta.tums.ac.ir/index.php/acta/article/download/4537/4659

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 11 2014 11 15 844 847 EN Alireza Mahoori Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Heydar Noroozinia Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Ebrahim Hasani Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Nazli Karami Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Nahid Pashaei Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. Sanaz Hatami Department of Anesthesiology, School of Medicine, Urmia University of Medical Sciences, Urmia, Iran. 2015 10 11 Emergence from general anesthesia can be associated with coughing, agitation, and hemodynamic disturbances. Remifentanil may attenuate these responses. We have examined the effect of remifentanil on the hemodynamic response to the emergence from anesthesia and tracheal extubation. In a double-blind, randomized trial, we enrolled 50 adult patients undergoing abdominal surgery. All patients received a standard general anesthetic comprising propofol, atracurium and 1% isoflurane with 50% nitrous oxide in oxygen. At the end of surgery, a bolus dose of remifentanil 0.2 microgram/kg (n = 25) or saline placebo (n = 25) was given and tracheal extubation was performed when standard criteria were achieved. Arterial pressure and heart rate were measured non-invasively, immediately after tracheal extubation and then at 1-min intervals. Remifentanil attenuated the increase in both systolic and diastolic arterial pressure and heart rate after extubation compared to the control group. No differences in SpO2, cough and laryngospasm were observed between two groups. Use of a low-dose remifentanil has clinically acceptable effect in blunting the cardiovascular changes induced by tracheal extubation. https://acta.tums.ac.ir/index.php/acta/article/view/4536 https://acta.tums.ac.ir/index.php/acta/article/download/4536/4660

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 11 2014 11 15 848 854 EN Mohammad Taghi Talebian Pre-Hospital Emergency Research Center, Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Mahdi Zamani Department of Anesthesiology and Pain Medicine, Tehran University of Medical Sciences, Tehran, Iran. Alireza Toliat Pre-Hospital Emergency Research Center, Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. Rezvaneh Ghasemzadeh Department of Medicine, University of Wisconsin, Madison, WI, USA. Morteza Saeedi Pre-Hospital Emergency Research Center, Department of Emergency Medicine, Shariati Hospital, Tehran Univeristy of Medical Sciences, Tehran, Iran. Mehdi Momeni Pre-Hospital Emergency Research Center, Department of Emergency Medicine, Shariati Hospital, Tehran Univeristy of Medical Sciences, Tehran, Iran. Amir Nejati Pre-Hospital Emergency Research Center, Department of Emergency Medicine, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 An electrocardiogram (ECG) leads physicians to diagnose many potentially life-threatening cardiac, metabolic, electrolyte, and toxicological conditions. This study was designed to evaluate the competency of emergency medicine residents (EMRs) in comparison with cardiologists in the interpretation of ECG when an interpretation checklist is used. This clinical trial was done in the emergency wards of the first grand general hospital of Iran. Patients were categorized in three classes of disorder severity based on ECG abnormalities. The two stages of the study included the survey phase (Stage I), training phase and intervention phase (Stage II). Accuracy of ECG interpretation by EMRs and cardiologists was compared before and after using a Daily ECG Check List (DECKList). One hundred and fifty ECGs were evaluated in Stage I, before DECKList usage, and 150 ECGs were evaluated in stage II, after DECKList usage by EMRs. Mean age of participants was 60.13 years in Stage I and 61.66 years in Stage II. Stage I and II were similar to each other in terms of disorder severity (P=0.22). Mean the ECG interpretation score was significantly different between Stages I and II (P<0.001). Concordance of ECG diagnosis between EMRs and cardiologists was significantly different in Stages I and II (P<0.01). In first-year EMRs, ECG diagnosis scores in stages I and II were not changed significantly. However, ECG interpretation scores increased significantly in first-year EMRs (P=0.04). In second-year EMRs, both ECG interpretation and ECG diagnosis scores improved significantly (P<0.05 and P<0.01, respectively). In third year EMRs, ECG interpretation was not improved but ECG diagnosis based on two methods improved significantly (P<0.05). The significant increase in accuracy of ECG interpretation and final diagnosis can be attributed to the utilization of a checklist by EMRs especially in the first year and second residents. https://acta.tums.ac.ir/index.php/acta/article/view/4535 https://acta.tums.ac.ir/index.php/acta/article/download/4535/4661

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 11 2014 11 15 855 859 EN Mohammad Ali Abbasi Moghadam Department of Healthcare Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Fayaz Bakhsh Department of Healthcare Management, school of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Hospital information system (HIS) should ideally allow different forms of data to be stored and used for decision making by clinicians and managers alike. This system has been developed since the early 1980's, and many hospitals gradually converted from an unrelated system into an integrated one. In successful implementation of HIS plans, the role of human factors, either individually or as a group, is expected to be very important and decisive. In this phenomenological qualitative research, in-depth personal interviews were conducted with the hospital's senior managers, and discussions were conducted in six to eight member focus groups. To include participants for interviews, purposive sampling was used in an Iranian hospital among doctors, nurses and other healthcare providers who had experience in using HIS. Data collection continued until saturation stage. The meetings took about 90 to 120 minutes, in which the participants were asked about discovering needs as well as facilitating and inhibiting factors regarding HIS application. Two members of the research team independently analyzed the interview transcripts.  As a result, problems in HIS isolation were reported to be related to the following: software, hardware, manpower, management and training. About the last point, it was stated that adequate continuing professional development programs did not exist for proper use of computers in the hospital. To achieve the ultimate goal of HISs (e.g. increasing patient satisfaction and decreasing hospital costs), it is necessary to create basic changes in the training system, and to get feedback from hospital personnel. Other steps include addressing software and hardware shortcomings as well as moving towards reinforcing the facilitating factors and refraining from inhibiting ones discovered in this study. https://acta.tums.ac.ir/index.php/acta/article/view/4534 https://acta.tums.ac.ir/index.php/acta/article/download/4534/4662

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 11 2014 11 15 860 864 EN Farnoosh Golband Department of E-learning in Medical Education, Virtual School, Tehran University of Medical Sciences, Tehran, Iran. Agha Fatemeh Hosseini Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran. Rita Mojtahedzadeh Department of E-learning in Medical Education, Virtual School, Tehran University of Medical Sciences, Tehran, Iran. Fakhrossadat Mirhosseini Department of E-learning in Medical Education, Virtual School, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Anesthesia, School of Allied Health Sciences, Kashan University of Medical Sciences, Kashan, and PhD Student, Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Shoaleh Bigdeli Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, school of Medicine, Iran University of Medical Sciences, Tehran, Iran. 2015 10 11 E-learning as an educational approach has been adopted by diverse educational and academic centers worldwide as it facilitates learning in facing the challenges of the new era in education. Considering the significance of virtual education and its growing practice, it is of vital importance to examine its components for promoting and maintaining success. This analytical cross-sectional study was an attempt to determine the relationship between four factors of content, educator, learner and system, and effective e-learning in terms of demographic variables, including age, gender, educational background, and marital status of postgraduate master's students (MSc) studying at virtual faculty of Tehran University of Medical Sciences. The sample was selected by census (n=60); a demographic data gathering tool and a researcher-made questionnaire were used to collect data. The face and content validity of both tools were confirmed and the results were analyzed by descriptive statistics (frequency, percentile, standard deviation and mean) and inferential statistics (independent t-test, Scheffe's test, one-way ANOVA and Pearson correlation test) by using SPSS (V.16). The present study revealed that There was no statistically significant relationship between age and marital status and effective e-learning (P>0.05); whereas, there was a statistically significant difference between gender and educational background with effective e-learning (P<0.05). Knowing the extent to which these factors can influence effective e-learning can help managers and designers to make the right decisions about educational components of e-learning, i.e. content, educator, system and learner and improve them to create a more productive learning environment for learners. https://acta.tums.ac.ir/index.php/acta/article/view/4533 https://acta.tums.ac.ir/index.php/acta/article/download/4533/4663

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 11 2014 11 15 865 867 EN Hossein Nough Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mostafa Bagherinasab Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mahmood Emami Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Mohammadtaghi Sarebanhassanabadi Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran. Leila Hadiani Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.