Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 9 2014 09 15 4673 4673 EN Nima Rezaei Editorial assistant, Acta Medica Iranica. Department of Immunology, School of Medicine. And Research Center for Immunodeficiency, Children's Medical Center Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 No Abstract https://acta.tums.ac.ir/index.php/acta/article/view/4673 https://acta.tums.ac.ir/index.php/acta/article/download/4673/4744

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 9 2014 09 15 651 655 EN Parisa Goodarzi Brain and Spinal Cord Injury Research Center, Cellule Fanavaran Knowledge-Based Organization, Tehran University of Medical Sciences, Tehran, Iran. Hamid Reza Aghayan Brain and Spinal Cord Injury Research Center, Cellule Fanavaran Knowledge-Based Organization, Tehran University of Medical Sciences, Tehran, Iran. AND Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Masoud Soleimani Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Hematology, Faculty of Medicine, Tarbiat Modares University, Tehran, Iran. Abbas Norouzi-Javidan Brain and Spinal Cord Injury Research Center, Cellule Fanavaran Knowledge-Based Organization, Tehran University of Medical Sciences, Tehran, Iran. Fereshteh Mohamadi-Jahani Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. Sharareh Jahangiri Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. Seyed Hasan Emami-Razavi Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. Bagher Larijani Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran. Babak Arjmand Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical Sciences, Tehran, Iran. AND Brain and Spinal Cord Injury Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Epilepsy as one of the most common neurological disorders affects more than 50 million people worldwide with a higher prevalence rate in low-income countries. Excessive electrical discharges in neurons following neural cell damage or loss cause recurrent seizures. One of the most common and difficult to treat types of epilepsy is temporal lobe epilepsy (TLE) which results from hippocampal sclerosis. Nowadays, similar to other diseases, epilepsy also is a candidate for treatment with different types of stem cells. Various stem cell types were used for treatment of epilepsy in basic and experimental researches. Two major roles of stem cell therapy in epilepsy are prophylaxis against chronic epilepsy and amelioration cognitive function after the occurrence of TLE. Several animal studies have supported the use of these cells for treating drug-resistant TLE. Although stem cell therapy seems like a promising approach for treatment of epilepsy in the future however, there are some serious safety and ethical concerns that are needed to be eliminated before clinical application. https://acta.tums.ac.ir/index.php/acta/article/view/4670 https://acta.tums.ac.ir/index.php/acta/article/download/4670/4623

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 9 2014 09 15 656 663 EN Hamid Reza Rahimi Department of Toxicology and Pharmacology, Faculty of Pharmacy, Pharmaceutical Nanotechnology Research Center,Tehran University of Medical Sciences, Tehran, Iran. Ahmad Reza Dehpour Department of Pharmacology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Shahram Ejtemaei Mehr Department of Pharmacology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Sharifzadeh Department of Toxicology and Pharmacology, Faculty of Pharmacy, Pharmaceutical Nanotechnology Research Center,Tehran University of Medical Sciences, Tehran, Iran. Mohammad Hossein Ghahremani Department of Toxicology and Pharmacology, Faculty of Pharmacy, Pharmaceutical Nanotechnology Research Center,Tehran University of Medical Sciences, Tehran, Iran. Ali Razmi Department of Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran. Seyed Nasser Ostad Department of Toxicology and Pharmacology, Faculty of Pharmacy, Pharmaceutical Nanotechnology Research Center,Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Cannabis is one of the most banned drugs in the world. Cannabinoid-induced dependence or withdrawal signs are indicated by the result of complex molecular mechanisms including upstream protein kinases (PKs), such as an extracellular signal regulated kinase1/2 (ERK1/2) and downstream glycogen synthase kinase-3β (GSK-3β), which lead to neuronal plasticity. In this study, we examined the protective effect of lithium (Li) as a potent ERK1/2 and GSK-3β modulator to prevent the development of dependence on cannabinoids. For this purpose, rats were treated twice daily with increasing doses of WIN 55,212-2 (WIN, 2-8 mg/kg, intraperitoneally (i.p.), for five consecutive days. AM251 (AM, 2 mg/kg), a cannabinoid antagonist, was injected i.p to induce manifestations of abstinence in rat dependency on WIN, and the subsequent withdrawal signs were recorded. To evaluate the preventive effect of Li, the rats were pre-treated with Li (10 mg/kg, i.p.) twice daily, 30 minutes before every injection of WIN. SL327, as an ERK1/2 inhibitor, was also injected (SL, 50 mg/kg, i.p.) 30 minutes before the last doses of WIN in separate groups. The p-ERK1/2, total ERK1/2, p-GSK-3β and total GSK-3β expressions were determined with Western blot method after 60 minutes, prior to the Li, WIN or AM injections. Li and SL pre-treatment attenuated the global withdrawal signs in regarding their modulation effect on the up-regulation of p-ERK1/2 cascade enhanced by AM injection. Furthermore, the p-GSK-3β expression was up-regulated with SL and Li pre-treatment against AM injection, without alteration on the total contents of ERK1/2 and GSK-3β level. Therefore, p-ERK1/2 and p-GSK-3β pathways are involved in the cannabinoid-induced dependence. However, no crosstalk was indicated between these two pathways. In conclusion, Li neuroprotectionwith regard to cannabinoid abstinence may occur through the regulation of the p-ERK1/2 cascade inconsequent of p-GSK-3β signaling pathways in rats. https://acta.tums.ac.ir/index.php/acta/article/view/4668 https://acta.tums.ac.ir/index.php/acta/article/download/4668/4624

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 9 2014 09 15 664 670 EN Zhoobin Heidari Bateni Department of Urology, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran. Hossein Shahrokh Department of Urology, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran. Hormoz Salimi Department of Urology, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran. Hossein Safari Department of Urology, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran. Meghdad Tabatabai Department of Urology, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran. Dariush Saedi Department of Radiology, Hasheminejad Hospital, Iran University of Medical Sciences, Tehran, Iran. 2015 10 11 To investigate and compare the infectious and non-infectious complications of single-dose versus multiple-dose antibiotic therapy for trans-rectal ultrasound (TRUS)-guided biopsy of the prostate. Patients were enrolled in a prospective randomized study that was designed to investigate the effects of single-dose versus multiple-dose antimicrobial prophylaxis regimen mainly on asymptomatic bacteriuria, urinary tract infection (UTI) without fever, fever and urinary septicemia. The single-dose group received one ciprofloxacin 500 mg tablet and two metronidazole 250 mg tablets at 2 hours before the biopsy, while the multiple-doses group received those every 12 hours from 3 days before the biopsy. One-hundred and sixty patients were evaluated in two groups and bacteriuria in urinalysis was encountered in 12 patients (15%) in the single-dose group and four patients (5%) in the multiple-dose group, with a significant difference (P=0.035). UTI without fever occurred in six patients (7.5%) in the single-dose group and one patient (1.25%) in the multiple-dose group, with no significant difference (borderline P=0.053). After biopsy, three patients (3.75%) returned with fever due to UTI and bacteremia in the single-dose group and none in the multiple-dose group, but with no significant difference (P=0.08). Regarding non-infectious complications, there were no significant differences between the two groups. Using prophylactic antibiotics for prostate biopsy in multiple doses, and at least 3 days before the procedure significantly reduces the rate of bacteriuria compared with a single-dose regimen. https://acta.tums.ac.ir/index.php/acta/article/view/4666 https://acta.tums.ac.ir/index.php/acta/article/download/4666/4625

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 9 2014 09 15 671 674 EN Paymaneh Alizadeh Taheri Department of Pediatrics, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. Negar Sajjadian Department of Pediatrics, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Bahram Beyrami Department of Pediatrics, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mamak Shariat Family Health Institute, Maternal Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Osteopenia of prematurity (OOP) is a preventable disease. Improved survival of premature newborns is associated with an increased incidence of OOP. The purpose of this study was to compare the prophylactic effects of two low doses of vitamin D (200 and 400 IU/Day) on the clinical, biochemical and radiological indices of the rickets of prematurity. In a randomized clinical trial, 60 preterm newborns with birth weight < 2000 g & gestational age < 37 weeks were randomly divided in two groups. Thirty newborns received 200 IU/d of vitamin D in group one and 30 ones received 400 IU/day of vitamin D in group two. On the 6th to 8th weeks of life, serum calcium, phosphate, alkaline phosphates, and 25-hydroxy vitamin D concentrations were measured and x- ray of left wrist and physical examination were performed. Both groups had no difference in biochemical, radiological or clinical presentation of rickets. Current study indicated that low dose vitamin D (200 IU/Day) is enough for prevention of OOP. https://acta.tums.ac.ir/index.php/acta/article/view/4664 https://acta.tums.ac.ir/index.php/acta/article/download/4664/4626

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 9 2014 09 15 675 680 EN Mehdi Hamedi Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammadreza Mohammdi Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ali Ghaleiha Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran. Zahra Keshavarzi Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Morteza Jafarnia Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Rasool Keramatfar Department of Psychiatry, AJA University of Medical Sciences, Tehran, Iran. Rosa Alikhani Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Abolfazl Ehyaii Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shahin Akhondzadeh Psychiatric Research Centre, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Attention-Deficit/Hyperactivity Disorder is one of the most common mental disorders in childhood, and it continues to adulthood without proper treatment. Stimulants have been used in the treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) for many years, and the efficacy of methylphenidate in the treatment of adults with ADHD has been proven to be acceptable according to meta-analysis studies. However, there are some concerns about stimulants. Finding other effective medications for the treatment of adult ADHD seems necessary. We hypothesized bupropion could be effective in the treatment of adult ADHD because some theoretical and experimental evidence exists to support efficacy of this medication. Forty-two patients with a diagnosis of ADHD, according to the revised fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, were randomized to receive 150 mg/day bupropion or placebo for a 6-week double-blind, placebo-controlled clinical trial. Each patient filled the Conners' Adult ADHD Rating Scales-Self-Report-Screening version (CAARS) before starting to take medication and in weeks 3 and 6 of the study. The mean score of the two groups receiving bupropion or placebo decreased over the 6 weeks. There was a significant difference between the two groups in CAARS score after 6 weeks. Bupropion is more effective than placebo in the treatment of adults with ADHD. Bupropion can be an alternative medication for the treatment of Adults with ADHD as its clinical efficacy was proven by other studies. https://acta.tums.ac.ir/index.php/acta/article/view/4661 https://acta.tums.ac.ir/index.php/acta/article/download/4661/4628

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 9 2014 09 15 681 686 EN Hassan Hashemi Noor Ophthalmology Research Center, Noor Eye Hospital, Tehranulmonary arterial pressure (SPAP) by echocardiographic methods among HIV-positive patients who received ART. This research is a descriptive, cross-sectional study of 170 HIV-positive patients that was conducted in Imam-Khomeini hospital, Tehran, Iran during 2011-2013. All patients regularly received antiretroviral therapy at least for recent 2 years. There were not any cardiopulmonary symptoms (cough, dyspnea, exertional fatigue and chest discomfort) in these patients. All participants underwent echocardiography to estimate SPAP. The participants comprised 108 males (63.5%) and 62 females (46.5%). The mean age of patients was 41 years old, and the mean duration of HIV infection was 5.5 years. The mean CD4 cell count was 401 cell/µl. The principal regimen of antiretroviral therapy included two nucleoside reverse transcriptase inhibitor (NRTI) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) in the hospital. The mean of systolic pulmonary arterial pressure was 25 mmHg in the participants; 156 (93.4%) of them had SPAP ≤ 30 mmHg (normal), six (3.6%) had SPAP: 31-35 mmHg (borderline) and five (3%) had SPAP > 35 mmHg (pulmonary hypertension). Our results indicated a significant increase of pulmonary hypertension in asymptomatic HIV-positive patients that had no association with any other risk factor. Also, antiretroviral therapy was not a risk factor for pulmonary hypertension in this study. 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. 2015 10 11 Aneurysm can develop in all arteries of the human body. Pseudoaneurysm induced by trauma is known as a rare condition in peripheral arteries. This complication is known as late sequelae of trauma. The incidence of pseudoaneurysm in upper extremities artery is less than lower extremities. Atherosclerotic aneurysms are often seen in large arteries and by aging, but pseudoaneurysm can be seen in penetrating or blunt trauma in patients of every age or every location. Delayed treatment of pseudoaneurysm leads to bleeding, venous edema at the extremities and compression on the adjacent nerve as a result of pseudoaneurysm enlargement. Early diagnosis of pseudoaneurysm is very important, because this complication can induce disabilities such as upper extremities and finger loss. Peripheral arteries pseudoaneurysm in distal locations especially in brachial artery and forearm can cause a thrombotic complication in hands and fingers. https://acta.tums.ac.ir/index.php/acta/article/view/4532 https://acta.tums.ac.ir/index.php/acta/article/download/4532/4664

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 11 2014 11 15 868 871 EN Hadi Rokni-Yazdi Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Imaging Medical Center, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mahsa Ghajarzadeh Brain and Spinal Injury Repair Research Center, Tehran University of Medical Sciences, Tehran, Iran. Amir Hossein Keyvan Department of Infectious Diseases, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Javad Namavar Department of Infectious Diseases, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Sepehr Azizi Department of Infectious Diseases, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Venous malformations are the most common form of symptomatic vascular malformations. VM s could classify into low-flow lesions (VMs) and high-flow lesions (AVMs). For low-flow venous lesions, direct percutaneous puncture with injection of sclerosing agents (sclerotherapy) has been described as a successful therapy. In this article, we want to introduce a patient who treated with ethanol sclerotherapy for VM located in the right flank. The patients were a 35-year-old man with right flank mass, skin discoloration and hemorrhagic foci. Color Doppler ultrasonography showed low flow vascular malformation while Magnetic Resonance Imaging (MRI) showed that the mass contained fat tissue with branching tubular signal void structures inside. The draining vein was first coiled via tortuous venous malformation vessels access and then VM was embolized.Under ultrasonographic guide, direct puncture of one branches of venous malformation wa