Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 582 590 EN Payam Dindoost Department of Gastroenterology, Middle East Liver Diseases Center (MELD Centers), Tehran, Iran. Narges Chimeh Department of Psychiatry, Family Research Institute, Shahid Beheshti University, Tehran, Iran. Blain F Hollinger Department of Gastroenterology, Baylor College of Medicine One Baylor Plaza, Houston, USA. Esmaeil Saberfar Department of Virology, Bayerpaul (BP) Vaccines and Pharmaceutical Company, Tehran, Iran. Mehdi Norouzi Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Seyed Mohammad Jazayeri Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Occult hepatitis B (OHB), or persistent hepatitis B virus (HBV) viremia in surface-antigen-HBsAg-negative patients, has been recognized as a medical concern during the last decade. The exact magnitude, pathogenesis and clinical relevance of OHB are unclear. This review organizes the published data on OHB and presents an overview of the current hypotheses on OHB's pathogenesis and clinical relevance.Many explanations have been offered for the pathogenesis of OHB, ranging from the inability of standard immunoassays to diagnose OHB to the involvement of the versatile virus-host factors. Also, special care should be taken regarding the diagnosis of OBH. It seems that both shared viral-host factors are involved in the pathogenesis of OBH. Further molecular studies on cohort patients group need to explore such association. https://acta.tums.ac.ir/index.php/acta/article/view/4570 https://acta.tums.ac.ir/index.php/acta/article/download/4570/4262

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 591 595 EN Ebrahim Eskandari-Nasab Genetic of Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran. AND Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Eslam Kharazi-Nejad Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Alireza Nakhaee Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Masoumeh Afzali Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Seyed Payman Tabatabaei Department of Cardiology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Kourosh Tirgar-Fakheri Department of Anesthesiology, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. Mohammad Hashemi Department of Clinical Biochemistry, Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran. 2015 10 11 Compelling evidence suggests that the oxidative stress plays a key role in the pathophysiology of cardiovascular disease (CVD). Superoxide dismutase (SOD) enzymes play a major role in detoxification of reactive oxygen species and protection against oxidative stress. We examined the possible association between a 50-bp insertion/deletion in the SOD1 promoter 1684-bp upstream of the SOD1 ATG with CVD in an Iranian population. A total of 400 individuals including 200 CVD patients and 200 healthy subjects from the same ethnic background as the control group were participated in this study. Genomic DNA from all subjects was screened for the 50-bp SOD1 promoter deletion using a polymerase chain reaction (PCR) assay. Our finding showed an association between SOD1 DEL/DEL (9% vs. 2.5%) and INS/DEL genotypes and risk of CVD and these genotypes increased the susceptibility to CVD (OR=2.096, 95% CI: 1.336-3.286, P= 0.001 for the INS/DEL genotype; OR=4.811, 95% CI: 1.734-13.346, P= 0.003 for the DEL/DEL genotype). Additionally, the DEL allele of the SOD1 variation was found to be more prevalent in the CVD patients with the frequency of 26.3% and 13.5% in cases and controls, respectively, and this difference reached statistical significance (OR=2.281, 95% CI: 1.586-3.279, P= 0.001).  The analysis of SOD1 genotypes according to patients' characteristics revealed that the SOD1 Ins/del and Del/Del genotypes were more prevalent in CVD patients with a history of CVD or hypertension or DM (P<0.05), whereas the majority of Ins/Ins genotype carriers had no history of these diseases. Overall, our results demonstrated that SOD1 50-bp Del/Del and Ins/Del genotypes, as well as Del, allele, were associated with an increased risk of CVD. https://acta.tums.ac.ir/index.php/acta/article/view/4569 https://acta.tums.ac.ir/index.php/acta/article/download/4569/4267

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 596 600 EN Fatemeh Sadat Nayeri Department of Pediatrics, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Tahereh Esmaeilnia Shirvani Department of Pediatrics, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Majid Aminnezhad Department of Pediatrics, Maternal-Fetal & Neonatal Research Center, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Elaheh Amini Department of Pediatrics, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Hossein Dalili Department of Pediatrics, Valiasr Hospital, Tehran University of Medical Sciences, Tehran, Iran. Faezeh Moghimpour Bijani Department of Medicine, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Administration of endotracheal surfactant is potentially the main treatment for neonates suffering from RDS (Respiratory Distress Syndrome), which is followed by mechanical ventilation. Late and severe complications may develop as a consequence of using mechanical ventilation. In this study, conventional methods for treatment of RDS are compared with surfactant administration, use of mechanical ventilation for a brief period and NCPAP (Nasal Continuous Positive Airway Pressure), (INSURE method ((Intubation, Surfactant administration and extubation)). A randomized clinical trial study was performed, including all newborn infants with diagnosed RDS and a gestational age of 35 weeks or less, who were admitted in NICU of Valiasr hospital. The patients were then divided randomly into two CMV (Conventional Mechanical Ventilation) and INSURE groups. Surfactant administration and consequent long-term mechanical ventilation were done in the first group (CMV group). In the second group (INSURE group), surfactant was administered followed by a short-term period of mechanical ventilation. The infants were then extubated, and NCPAP was embedded. The comparison included crucial duration of mechanical ventilation and oxygen therapy, IVH (Intraventricular Hemorrhage), PDA (Patent Ductus Arteriosus), air-leak syndromes, BPD (Broncho-Pulmonary Dysplasia) and mortality rate. The need for mechanical ventilation in 5th day of admission was 43% decreased (P=0.005) in INSURE group in comparison to CMV group. A decline (P=0.01) in the incidence of IVH and PDA was also achieved. Pneumothorax, chronic pulmonary disease and mortality rates, were not significantly different among two groups. (P=0.25, P=0.14, P=0.25, respectively). This study indicated that INSURE method in the treatment of RDS decreases the need for mechanical ventilation and oxygen-therapy in preterm neonates. Moreover, relevant complications as IVH and PDA were observed to be reduced. Thus, it seems rationale to perform this method as the initial treatment for neonates with mild to moderate RDS. https://acta.tums.ac.ir/index.php/acta/article/view/4568 https://acta.tums.ac.ir/index.php/acta/article/download/4568/4315

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 601 606 EN Akram Beheshti Department of Dermatology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Hodda Ghadami Department of Dermatology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Ameneh Barikani Department of Community Medicine, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Fatemeh Haj Manouchehri Department of Pathology, Faculty of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. 2015 10 11 Vitiligo Vulgaris is a pigment disorder as the lack of skin pigmentation which its most prevalent cause is autoimmune. Vitamin D has various effects on the natural and acquired immune of the body because of its effectiveness on the T cells and B cells, macrophages and dendritic cells.The object of this study was assessment of the Vitamin D in patients with vitiligo vulgaris in dermatologic clinics in Qazvin in 2012. The 100 patients with Vitiligo were studied through a cross-sectional study. The required data were collected by the questionnaire (age, gender, job, family background, consumption of the dairies and vitamin D supplements), examination (type of skin) and para clinical test (measurement of the serum 25-hydroxyvitamin D level). The 42 (42%) and 58 (58%) people of the population under study were respectively male and female. The mean age of the population under study was 28.7±1.17. The mean serum of 25-hydroxyvitamin D level was 42±24.14 which had a significance difference with a normal level (p<0.04). The mean serum 25-hydroxyvitamin D level among patients with Vitiligo had a significance difference with a normal level. https://acta.tums.ac.ir/index.php/acta/article/view/4567 https://acta.tums.ac.ir/index.php/acta/article/download/4567/4284

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 607 612 EN Elaheh Hooshmand Department of Health and Management, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran. AND Department of Health and Management, Health Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Sogand Tourani Department of Health Services Management, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran. Hamid Ravaghi Department of Health Services Management, Faculty of Health, Iran University of Medical Sciences, Tehran, Iran. Hossein Ebrahimipour Department of Health and Management, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran. AND Department of Health and Management, Health Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2015 10 11 Lack of scientific and confirmed researches and expert knowledge about evaluation systems for clinical governance development in Iran have made studies on different evaluation systems for clinical governance development a necessity. These studies must provide applied strategies to design criteria of implementing clinical governance for hospital's accreditation. This is a descriptive and comparative study on development of clinical governance models all over the world. Data have been gathered by reviewing related articles. Models have been studied in comprehensive review method. The evaluated models of clinical governance development were Australian, NHS, SPOCK and OPTIGOV. The final aspects extracted from these models were Responsiveness, Policies and Strategies, Organizational Structure, Allocating Resources, Education and Occupational Development, Performance Evaluation, External Evaluation, Patient Oriented Approach, Risk Management, Personnel's Participation, Information Technology, Human Resources, Research and Development, Evidence Based Medicine, Clinical Audit, Health Technology Assessment and Quality. These results are applicable for completing the present criteria which evaluating clinical governance application and provide practical framework to evaluate country's hospital on the basis of clinical governance elements. https://acta.tums.ac.ir/index.php/acta/article/view/4566 https://acta.tums.ac.ir/index.php/acta/article/download/4566/4296

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 613 618 EN Payam Sarraf Department of Neurology, Iranian Center of Neurological Research, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mahrooz Malek Department of Radiology, Medical Imaging Center, Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imam Khomeini Hospital, Tehran Iran. Mahsa Ghajarzadeh Department of Neurology, Brain and Spinal Injury Research Center (BASIR), Tehran University of Medical Sciences, Tehran, Iran. Shahin Miri Department of Medical, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Ehsan Parhizgar Department of Medical, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Seyedeh Zahra Emami-Razavi Department of Physical Medicine & Rehabilitation, Brain and Spinal Injury Research Center (BASIR), Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. It accounts 90% of all entrapment neuropathies all over the world. Ultrasound is a non-invasive, cost effective and available para-clinical method which could be applied for CTS diagnosis. Cross-sectional area of the median nerve at the level of the inlet is considered as a diagnostic criterion in CTS cases. In this study, thirty-eight patients with electrophysiologically confirmed idiopathic CTS and 22 healthy controls were enrolled. Seventy-one affected nerves and 42 unaffected nerves were evaluated within 14 days after electrophysiological examination. The largest cross-sectional area (CSA) was measured at the level of the carpal tunnel inlet and the maximum nerve perimeter was also recorded by means of the software. Mean CSA and perimeter were 14.02 ± 4.5 mm2 and 1.7±0.28m in all patients and 8.2±2.1 mm2, 1.3±0.19 m in controls (P<0.001, P<0.001). Mean CSA and Perimeter were significantly different between patient's groups and control. The best cut off point for CSA of the tunnel inlet was 10.5 mm2 with sensitivity and specificity of 80% and 76% (AUC (Area under the Curve) = 0.9, P<0.001). The best cut off point for inlet perimeter was 1.44 m with sensitivity and specificity of 85% and 77 % (AUC=0.87, P<0.001). Our findings showed that median nerve CSA at carpal tunnel inlet could be used as the diagnostic criteria for CTS. https://acta.tums.ac.ir/index.php/acta/article/view/4565 https://acta.tums.ac.ir/index.php/acta/article/download/4565/4332

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 8 2014 08 15 619 622 EN https://acta.tums.ac.ir/index.php/acta/article/view/5682 https://acta.tums.ac.ir/index.php/acta/article/download/5682/4801

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 6 2016 06 08 376 381 EN Somayeh Sharifynia Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Hamid Badali Department of Medical Mycology and Parasitology, Pharmaceutical Sciences Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, Iran. Mina Sharifi Sorkherizi Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Reza Shidfar Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Atefe Hadian Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Shadi Shahrokhi Islamic Azad University, Varamin-Pishva Branch, Varamin, Iran. Ghazale Ghandchi Pediatric Infections Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Sassan Rezaie Department of Medical Mycology and Parasitology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 18 2015 12 07 Candidiasis, the main opportunistic fungal infection has been increased over the past decades. This study aimed to characterize C.albicans species complex (C.albicans, C.dubliniensis, and C.africana) isolated from patients with respiratory infections by molecular tools and in vitro antifungal susceptibilities by using broth microdilution method according to CLSI M27-A3 guidelines. Totally, 121 respiratory samples were collected from patients with respiratory infections. Of these, 83 strains were germ tube positive and green colonies on chromogenic media, so initially identified as C.albicans species complex and subsequently were classified as C.albicans (89.15%), C.dubliniensis (9.63%), and C.africana (1.2%) based on PCR-RFLP and amplification of hwp1 gene. Minimum inhibitory concentration (MICs) results showed that all tested isolates of C.albicans complex were highly susceptible to triazole drugs. However, caspofungin had highest activity against C.albicans, C.dubliniensis, and C.africana. Our findings indicated the variety of antifungal resistance of Candida strains in different areas. These results may increase the knowledge about the local distribution of the mentioned strains as well as their antifungal susceptibility pattern which play an important role in appropriate therapy. https://acta.tums.ac.ir/index.php/acta/article/view/4996 https://acta.tums.ac.ir/index.php/acta/article/download/4996/4802

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 6 2016 06 08 382 390 EN Gholamali Yousefipour Department of Neurology Sciences, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Zabihollah Hashemzahi Department of Neurology Sciences, Clinical Neurology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Masood Yasemi Department of Ophthalmology, Poostchi Eye Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Pegah Jahani Department of Medicine, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. 2015 09 29 2016 02 28 Multiple sclerosis (MS) is the most prevalent disease caused by the inflammatory demyelinating process that causes progressive nervous system degeneration over the time. Optical Coherence Tomography (OCT) is a non-invasive optical imaging technology, which can measure the thickness of retinal nerve fiber layer as well as the diameter of the macula. The purpose of the study is evaluation OCT findings in two common types of multiple sclerosis. For doing the cross-sectional study, 63 patients with two prevalent types of multiple sclerosis (35 patients with Relapse Remitting Multiple Sclerosis (RRMS) and 28 patients with Secondary Progressive Multiple Sclerosis (SPMS) were evaluated for 6 months. Exclusion criteria of the study were a history of optic neuritis, suffering from diabetes mellitus, hypertension, ocular disease, and the presence of other neurologic degenerative diseases. Then, the thickness of retinal nerve fiber layer (RNFL), as well as thickness and volume of the macula, were measured in the patients using OCT technology. The disability rate of patients was evaluated according to Expanded Disability Status Scale (EDSS). Finally, data was analyzed by means of SPSS software. Overall, 35 patients with RRMS (with mean age of 32.37+10.01, average disease period of 3.81+3.42 and mean EDSS of 1.84+0.45) and 28 patients with SPMS (with mean age of 39.21+9.33, average disease period of 11.32+5.87 and mean EDSS of 5.12+1.46) were assessed and compared in terms of retinal nerve fiber layer and size and thickness of macula. In all of these sections, the thicknesses were smaller in SPMS patients than patients with RRMS. But, there was a significant difference in total thickness (81.82µm versus 96.03µm with P=0.04) and thickness of temporal sector (54.5 µm versus 69.34 µm with P=0.04) of retinal nerve fiber layer and macular size at the superior sector of external ring (1.48 mm³ versus 1.58 mm³ with P=0.03), and nasal sector of external ring surrounding macula (1.53 mm³ versus 1.66 mm³ with P=0.03). No significant correlation was found among rising disability and reduced thickness of macula and optic nervous layer. Based on the study results, it can be said that OCT is a useful method for showing axonal degeneration severity and evaluation of various drugs effects on the course of MS disease, and thus we can change drugs based on OCT findings for achieving best results. https://acta.tums.ac.ir/index.php/acta/article/view/4242 https://acta.tums.ac.ir/index.php/acta/article/download/4242/4803

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 6 2016 06 08 391 394 EN Mojtaba Chardoli Department of Emergency Medicine, Haftom-e-Tir Hospital, Iran University of Medical Sciences, Tehran, Iran. Nader H. Firoozabadi Department of Emergency Medicine, Haftom-e-Tir Hospital, Iran University of Medical Sciences, Tehran, Iran. Mohsen Nouri Department of Neurosurgery, Razi Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 11 2016 02 22 Cerebrovascular attack (CVA) and transient ischemic attack (TIA) are major causes of emergency department visits around the globe. A significant number of these patients may experience repeat attacks if left untreated. Several risk stratifying scoring systems have been developed in recent years to point out the high risk patients. ABCD2 is based on age, blood pressure, clinical status, diabetes mellitus, and duration of symptoms and is used commonly for this purpose. In this study, we were to enhance its sensitivity and specificity with the addition of another criterion namely atrial fibrillation and making ABCD2-F. A prospective study in two hospitals was performed and 138 patients diagnosed with TIA/CVA were enrolled. Demographic, clinical, and paraclinical data of all patients were registered. All patients were followed for three months for any sign or symptom of a recurrent ischemic attack. Recurrent ischemic attacks happened in 9.4% of the patients. None of the criteria of ABCD2-F was associated with higher chance of ischemic attacks. Similarly, ABCD2-F was not different between patients with or without repeat cerebral ischemia. The addition of atrial fibrillation to ABCD2 did not enhance the accuracy of this scoring system to detect patients high risk for repeat cerebral ischemia. More studies in the future to improve sensitivity and specificity of this test are warranted. https://acta.tums.ac.ir/index.php/acta/article/view/5130 https://acta.tums.ac.ir/index.php/acta/article/download/5130/4804

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 6 2016 06 08 395 400 EN Fatemeh Farahmand Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Tayebeh Mohammadi Department of Pediatrics, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. Mehri Najafi Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Gholamhosein Fallahi Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmad Khodadad Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Farzaneh Motamed Department of Pediatric Gastroenterology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran. Sayed Mahdi Marashi Department of Forensic Medicine and Clinical Toxicology, Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. Maryam Shoaran Department of Pediatrics, Pediatric Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Raheleh Nabavizadeh Rafsanjani Department of Pediatrics, Children’s Medical Center, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran. 2016 06 05 Helicobacter pylori infection is a prevalent disease among Iranian children. The purpose of this study was to compare the effect of ciprofloxacin and furazolidone on eradicating helicobacter pylori in Iranian children in combination with amoxicillin and omeprazole. In this cohort study, helicobacter pylori infection was confirmed by gastroscopy, rapid urease test or pathologic assessments. A total of 66 children were randomly enrolled; based on the random number table, and were divided into two groups; first, a combination regimen consisting of ciprofloxacin, amoxicillin, and omeprazole; second, a three-medication regimen consisting of amoxicillin, furazolidone, and omeprazole. The effect of both medical regimens on the successful eradication of helicobacter pylori infection was assessed and compared. Chi-square test was used for evaluating the association between quantitative variables. All comparisons were made at the significance of P<0.05. Endoscopic tests prior to initiating treatments showed that 66.7% of the patients had a degree of nodularity while peptic ulcer was only observed in one patient. One month after the end of the treatments, eradication of the helicobacter pylori infection was reported 87.9% (29/33) in the first group (CAO) and 60.6% (20.33) in the second group (FAO) (P=0.011). It appears that a major advantage of our proposed regimen over others is a lack of wide use of fluoroquinolones for treating children’s diseases. Given FDA’s recommendation about the possibility of prescribing ciprofloxacin for infected patients with multidrug resistance, we can use the regimen proposed in this study in patients with resistance to standard treatments. https://acta.tums.ac.ir/index.php/acta/article/view/5683 https://acta.tums.ac.ir/index.php/acta/article/download/5683/4805

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 6 2016 06 08 401 406 EN Rita Mojtahedzadeh Department of E-learning in Medical Education, Virtual School, Center of Excellence for E-learning in Medical Education, Tehran University of Medical Sciences, Tehran, Iran. Aeen Mohammadi Department of E-learning in Medical Education, Virtual School, Center of Excellence for E-learning in Medical Education, Tehran University of Medical Sciences, Tehran, Iran. Noushin Kohan Department of Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mitra Gharib Department of E-learning in Medical Education, Virtual School, Center of Excellence for E-learning in Medical Education, Tehran University of Medical Sciences, Tehran, Iran. Mitra Zolfaghari Department of E-learning in Medical Education, Virtual School, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 15 2015 11 28 Delphi as a consensus development technique enables anonymous, systematic refinement of expert opinion with the aim of arriving at a combined or consensual position. In this study, we determined the criteria and their weights for Iranian Medical Schools' ranking through a Delphi process. An expert committee devised 13 proposed criteria with 32 indicators with their weights, which were arranged hierarchically in the form of a tree diagram. We used the Delphi technique to reach a consensus on these criteria and weights