Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 12 2015 10 21 782 784 EN Asieh Mosallanejad Imam Hossein Medical Center, Shahid Beheshti University of Medical Science, Tehran, Iran. Fatemeh Sayarifard Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran. Sima Hosseinverdi Molecular Immunology Research Center, Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran. Farzaneh Abbasi Growth and Development Research Center, Tehran University of Medical Sciences, Tehran, Iran. Hosein Shabni Mirzaee Department of Pediatric Endocrinology, Bahrami Hospital, Tehran University of Medical Sciences,Tehran, Iran. Nima Rezaei Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medicl Sciences, Tehran, Iran. AND Universal Scientific Education and Research Network (USERN), Tehran, Iran. 2015 10 21 There is a number of syndromes, associated with proptosis, micrognathia, low-set ear and chest deformity. Herein, we report a 9-year-old female with such phenotype who was presented with a vaginal neuroma. The result of karyotype showed 47XX, with extra marker chromosome 22. Although such a manifestation had not been reported in the literature, it should be considered as a very rare manifestation of the disease. https://acta.tums.ac.ir/index.php/acta/article/view/5027 https://acta.tums.ac.ir/index.php/acta/article/download/5027/4694

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 12 2015 12 22 733 737 EN Seyed Mojtaba Marashi Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Seyed Mostafa Saeedinia Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mostafa Sadeghi Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ali Movafegh Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Shaqayeq Marashi Department of Anesthesiology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 21 A varieties of medications have been suggested to prevent hemodynamic instabilities following laryngoscopy and endotracheal intubation. This study was conducted to determine the beneficial effects of gabapentin on preventing hemodynamic instabilities associated with intubation in patients who were a candidate for coronary artery bypass surgery (CABG). This double blinded randomized, parallel group clinical trial was carried out on 58 normotensive patients scheduled for elective CABG under general anesthesia with endotracheal intubation in Shariati Hospital. Patients were randomly allocated to two groups of 29 patients that received 1200 mg of gabapentin in two dosages (600 mg, 8 hours before anesthesia induction and 600 mg, 2 hours before anesthesia induction) as gabapentin group or received talc powder as placebo (placebo group). Heart rate, mean arterial pressure, systolic and diastolic blood pressure were measured immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation. Inter-group comparisons significantly showed higher systolic and diastolic blood pressure, mean arterial pressure and heart rate immediately before intubation, during intubation, immediately after intubation, 1 and 2 minutes after tracheal intubation in the placebo group in comparison to gabapentin group. The median of anxiety  verbal analog scale (VAS) at the pre-induction room in gabapentin and placebo groups were 2 and 4,  respectively that was significantly lower in the former group (P. value =0.04 ); however, regarding median of pain score no difference was observed between them (P. value =0.07). Gabapentin (1200mg) given preoperatively can effectively attenuate the hemodynamic response to laryngoscopy, intubation and also reduce preoperative related anxiety in patients who were a candidate for CABG. https://acta.tums.ac.ir/index.php/acta/article/view/5289 https://acta.tums.ac.ir/index.php/acta/article/download/5289/4720

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 12 2015 12 22 785 788 EN Mahsa Ansari Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Farid Azmoodeh Ardalan Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Masoumeh Najafi Department of Surgery, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Azadeh Goodarzi Department of Dermatology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. Alireza Ghanadan Department of Pathology, Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. AND Department of Dermatopathology, Razi Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 22 Primary cutaneous anaplastic large cell lymphoma is a T-cell malignancy with atypical CD30 positive lymphocytes. Pseudoepitheliomatous hyperplasia is an uncommon finding in primary cutaneous anaplastic large cell lymphoma, and may mimic squamous cell carcinoma as pseudomalignancy. Careful attention of a pathologist to correct diagnosis of pseudoepitheliomatous hyperplasia and its underlying causes will help physicians to avoid inappropriate management. Here, we present a 22-year-old man referred to our hospital with a solitary nodule persistent on his forearm which was diagnosed as squamous cell carcinoma in the first biopsy. The lesion recurred after two months and histopathologic and immunohistochemistry examination revealed anaplastic large cell lymphoma with florid pseudoepitheliomatous hyperplasia which masquerading as well-differentiated squamous cell carcinoma. Diagnosis of pseudoepitheliomatous hyperplasia must guide the pathologist to search for underlying causes, such as primary cutaneous lymphoma. Pseudoepitheliomatous hyperplasia may mimic squamous cell carcinoma and this can result in inappropriate diagnosis and management. https://acta.tums.ac.ir/index.php/acta/article/view/5299 https://acta.tums.ac.ir/index.php/acta/article/download/5299/4727

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 12 2015 12 22 738 742 EN Koorosh Ahmadi Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran. Mohsen Ebrahimi Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Amir Masoud Hashemian Department of Emergency Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Saeed Sarshar Department of Emergency Medicine, Khorramabad University of Medical Sciences, Khorramabad, Iran. Vafa Rahimi-Movaghar Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 12 21 Macintosh direct laryngoscope has been the most widely used device for tracheal intubation. GlideScope video laryngoscope (GVL) has been recently introduced as an alternative device for performing intubation; however, its validity in emergency settings has not been thoroughly evaluated. The aim of this study was to compare Macintosh direct laryngoscope versus GVL for emergency endotracheal intubation. This quasi-randomized clinical trial was performed on 97 patients referred to Imam Reza Hospital whom all needed emergency intubation in 2011. Patients were divided into two groups of the easy airway and difficult airway; intubation was performed for patients with direct laryngoscopy or GVL. Then, the patients were evaluated in terms of demographic characteristics, successful intubation rate and intubation time. Data was analyzed by SPSS software 16. There was no significant difference in demographic characteristics of the patients in both easy airway and difficult airway groups who intubated with direct laryngoscopy and GVL methods (P>0.05). In difficult airway group, a significant difference was found in successful intubation at the first attempt (60.9% vs. 87.5%; P=0.036), overall intubation time (32.7 ± 14.58 vs. 22.5±7.88; P<0.001) and first attempt intubation time (28.43 ± 12.51 vs. 21.48±7.8; P=0.001) between direct laryngoscopy and GVL. These variables were not significantly different between two methods in easy airway group. According to the results, GVL can be a useful alternative to direct laryngoscopy in emergency situations and especially in cases with a difficult airway. https://acta.tums.ac.ir/index.php/acta/article/view/5290 https://acta.tums.ac.ir/index.php/acta/article/download/5290/4721

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 12 2015 10 20 789 792 EN Vitorino Modesto dos Santos Department of Internal Medicine, Armed Forces Hospital and Catholic University, Brasília-DF, Brazil . Christiane Aires Teixeira Department of Pneumology, Armed Forces Hospital, Brasília-DF, Brazil. Ana Carla Andrade Almeida Department of Pneumology, Armed Forces Hospital, Brasília-DF, Brazil. Alessandra Maria Rodrigues Oliveira Santos Department of Internal Medicine, Armed Forces Hospital and Catholic University, Brasília-DF, Brazil . Kátia Rejane Marques Brito Department of Internal Medicine, Hospital of West, Barreiras-BA, Brazil. Valerio Alves Ferreira Department of Radiology, Armed Forces Hospital, Brasília-DF, Brazil. 2015 10 20 Yellow nail syndrome (YNS) is an uncommon condition characterized by nail changes, lymphedema, in addition to pulmonary disorders and pleural effusion. Pericarditis and non-cardiac disorders can evolve with pericardial effusions including autoimmune conditions, hypothyroidism, malignancies, tuberculosis, and uremia. A 72-year-old Brazilian woman under treatment for arterial hypertension and hypothyroidism was admitted with pericarditis and pericardial effusion concomitant with yellow nail syndrome. She denied tobacco smoking, alcohol abuse, and similar disorders in her family. Clinical and complementary evaluation ruled out infectious diseases, malignancies, and autoimmune disorders as etiologic factors in this case. Hypothyroidism is a well-known cause of pericardial effusion, the vast majority in the absence of pericarditis, and has been described as an associated condition in some individuals with YNS. Case studies might contribute to better understanding of these causal or casual relationships. https://acta.tums.ac.ir/index.php/acta/article/view/5016 https://acta.tums.ac.ir/index.php/acta/article/download/5016/4688

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 12 2015 12 22 743 748 EN Shahpoor Maddah School of Medicine, Semnan University of Medical Sciences, Semnan, Iran. Jamileh Mahdizadeh School of Medicine, Semnan University of Medical Sciences, Semnan, Iran. 2015 12 21 The association of obesity and other metabolic conditions with osteoarthritis is under debate; however, a strong link between metabolic disturbances is suggested to contribute to increased incidences and progression of osteoarthritis. We examined the association of metabolic syndrome and its components with the incidence of knee osteoarthritis in Iranian population. A community-based study was conducted on a total of 625 Iranian volunteers with the complaint of knee pain. Weight-bearing and anteroposterior plain radiographs of both knees were taken on the day of admission. Metabolic syndrome was diagnosed using the modified Adult Treatment Panel III of the National Cholesterol Education Program criteria. Prevalence rates of metabolic syndrome were 22.5% in males and 11.6% in females (P=0.002). The prevalence rate of knee osteoarthritis was 20.0% in males and 43.8% of females (P<0.001). In both genders, osteoarthritis group had higher serum levels of triglyceride and systolic blood pressure in comparison with non-osteoarthritis group. Women with osteoarthritis had higher Body Mass Index (BMI), however, this association was not observed in men. In females, the presence of osteoarthritis was significantly associated with the presence of metabolic syndrome, with the risk of metabolic syndrome in the osteoarthritis group at 2.187 fold the risk in the non-osteoarthritis group. But, the presence of osteoarthritis was not associated with metabolic syndrome in males. Metabolic syndrome mainly through high BMI is associated with knee osteoarthritis in the Iranian women, but neither metabolic syndrome nor any related components are associated with knee osteoarthritis in men. https://acta.tums.ac.ir/index.php/acta/article/view/5291 https://acta.tums.ac.ir/index.php/acta/article/download/5291/4722

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 53 12 2015 12 22 749 752 EN Azim Mehrvar Department of Pediatric Hematology Oncology, MAHAK s’ Pediatric Cancer Treatment and Research Center, Army University of Medical Science, Tehran, Iran. Mohammad Saeid Rahiminejad Department of Pediatric Hematology Oncology, Children’s Medical Center, Tehran, Iran. Amir Abbas Hedayati Asl Department of Pediatric Hematology Oncology, MAHAK s’ Pediatric Cancer Treatment and Research Center, Azad University of Medical Science, Qom Branch, Qom, Iran. Maryam Tashvighi Department of Pediatric Hematology Oncology, MAHAK s’ Pediatric Cancer Treatment and Research Center, MAHAK Hospital, Tehran, Iran. Mohammad Faranoush Department of Pediatric Hematology Oncology, MAHAK s’ Pediatric Cancer Treatment and Research Center, Iran University of Medical Science, Tehran, Iran. Mardawig Alebouyeh Department of Pediatric Hematology Oncology, MAHAK s’ Pediatric Cancer Treatment and Research Center, Azad University of Medical Science, Qom Branch, Qom, Iran. Leili Kuchakzadeh Department of Pediatric Hematology Oncology, Children’s Medical Center, Tehran, Iran. Asghar Ramyar Department of Pediatric Hematology Oncology, Children‚ki Department of Dermatology, Molecular Dermatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Akbar Mokhtarpour Department of Dermatology, Ardebil University of Medical Sciences, Ardebil, Iran. Mohammad Reza Saki Department of Medicine, Student Research committee, Shiraz University of Medical Sciences, Shiraz, Iran. 2015 10 11 Hand eczema is a common distressing skin problem. It is an immune reaction to haptens. Thus, substances that inhibit Immune system can be effective in the treatment of hand eczema. In this study, topical fumaric acid 5% cream is compared with topical steroid in the treatment of hand eczema. Patients with hand eczema were randomly divided into two groups. One group received fumaric acid 5% in a cream base, and the other received triamcinolone 0.1% in the same cream base. Both groups used creams twice daily for one month. Patients were checked for erythema, excoriation, population and lichenification, EASI score, and pruritus before and after treatment. In both groups, the mean of all signs of the disease and EASI score decreased after one month of treatment. There was no significant difference between the two treatments in decreasing erythema, but excoriation, population, lichenification, EASI score and itching were all decreased more in triamcinolone 0.1 % group. Although fumaric acid can inhibit the immune system; it was less effective for the treatment of all signs of hand eczema except erythema in comparison to triamcinolone. These results may be justified for two reasons: low penetration of topical fumaric acid through the skin or a low concentration used in this study. https://acta.tums.ac.ir/index.php/acta/article/view/4580 https://acta.tums.ac.ir/index.php/acta/article/download/4580/4508

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 7 2014 07 15 532 544 EN Marjan Ghazisaeidi Department of Health Information Management, Faculty of allied medical Sciences, Tehran University Medical Sciences, Tehran, Iran. AND Department of Health Information Management, Faculty of Health Management and Information Sciences, Iran University Medical Sciences, Tehran, Iran. Maryam Ahmadi Health Management and Economics Research Center, Faculty of Health Management and Information Sciences, Iran University of Medical sciences, Tehran, Iran. AND Department of Health Information Management, Faculty of Health Management and Information Sciences, Iran University Medical Sciences, Tehran, Iran. Farahnaz Sadoughi Department of Health Information Management, Faculty of Health Management and Information Sciences, Iran University Medical Sciences, Tehran, Iran. . Reza Safdari Department of Health Information Management, Faculty of allied medical Sciences, Tehran University Medical Sciences, Tehran, Iran. 2015 10 11 Readiness assessment provides a proper image of the existing conditions and an explanation of facilitated operational plans and functional approaches to successful implementation of electronic health record. Readiness assessment requires indices adjusted to particular conditions in each country. Therefore, the present study attempts to provide an acceptable model in Iran and to provide an assessment of public and teaching hospitals in medical education university. After reviewing related papers and descriptive study of five selected countries, the initial model was designed in the form of a questionnaire for analysis through Delphi and distributed among 30 experts nationwide. Along identification of components in the proposed method, a 7-point Likert scale was used to determine priority of each component. Then, all general -education hospitals at Tehran University of Medical Education were examined based on this model in terms of total, relative, or no readiness. The final model was designed in five dimensions: cultural, leadership and management, technical infrastructure, governance and operational dimensions; Educational Hospitals were evaluated in this dimension. 28.6 % of general--teaching hospitals are ready for pre-implementation. It seems to establish uniform strategic and executive team in Health center is essential for the preparation them in abovementioned area in the least possible time. https://acta.tums.ac.ir/index.php/acta/article/view/4579 https://acta.tums.ac.ir/index.php/acta/article/download/4579/4509

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 7 2014 07 15 545 551 EN Abdolreza Medghalchi Eye Research Center, Amiralmomenin Hospital, Guilan University of Medical Science, Rasht, Iran. Mohammad Javad Mohammadi Eye Research Center, Amiralmomenin Hospital, Guilan University of Medical Science, Rasht, Iran. Reza Soltani Moghadam Eye Research Center, Amiralmomenin Hospital, Guilan University of Medical Science, Rasht, Iran. Hossein Dalili Departments of Pediatrics, Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 Congenital nasolacrimal duct obstruction (CNLDO) is a common disease in children. The classic treatment of CNLDO is probing that was done around one year old. However, controversy exists regarding the outcome of probing in children older than one year. This study aimed to find the cure rate of initial probing for CNLDO and identify factors producing the failure rate in old age. In this retrospective interventional case series study, 100 eyes of 92 patients aged 9-48 months with CNLDO underwent probing with general anesthesia. According to the intraoperative results of probing, CNLDO were categorized in two groups of membranous obstruction at the end of nasolacrimal duct obstruction (NLD) and complex obstruction at canaliculus, lacrimal sac and N LD. Patients were categorized in three groups according to the age of probing into under 12, 12 to 24 and over 24 months. Success rate was defined as successful irrigation of NLD intraoperatively and absence of lacrimation and discharge at 1 week, one, three and six months postoperatively. The average age of patients and probing were 47.35±25.59 and 17.32±7.85 months respectively. Membranous obstruction accounted for 72% of patients and remainder had complex type. An overall cure rate of 91%, 89% and 60% was found in patients aged 9-12, 12-24 and 24-48 months respectively. Surgery success rate after six months was 91% in membranous group and 52% in complex group. There was a significant relation between the type of obstruction and opening of NLD (p<0.O01). This study showed that the probing failure of probing after one year was related to the complexity of obstruction rather than the age of the patient. It is recommended that probing could safely be done in under 4 years old. https://acta.tums.ac.ir/index.php/acta/article/view/4578 https://acta.tums.ac.ir/index.php/acta/article/download/4578/4511

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 7 2014 07 15 552 556 EN Hossein Dalili Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Ahmadreza Farsar Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Hamed Barakati Child Health Office, Ministry of Health and Medical Education, Tehran, Iran. Farima Raji Maternal- fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Mamak Shariat Maternal- fetal & Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran. Farshad Pourmalek Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. Parvaneh Musavi Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Susan Saadvandian Child Health Office, Ministry of Health and Medical Education, Tehran, Iran. Manijeh Yunesi Deputy of Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Mohadeseh Fallahi Breastfeeding Research Center, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 This study was designed to assess the frequency of exclusive breastfeeding in two health centers of Shahid Beheshti University of Medical sciences in Khak Sefid, Tehran, Iran. A total of 175 mothers, referred for the third dose of their infants' DPT vaccination program participated in the study by completing a questionnaire regarding characteristics of their pregnancy, delivery and exclusive breastfeeding within the first six months of birth. Two-variable analysis and logistic regression test were applied to evaluate factors influencing exclusive breastfeeding. Results indicated that the frequency of exclusive breastfeeding, i.e., breastfeeding within the first six months of birth without the use of any other food with or without vitamin supplementation, was 31.17% (95% CI=23.77%-38.57%), which means 48 infants of 154<179 days old Among 154 infants (<179 days old) 48 did not have a history of being separated from their mothers. In logistic regression analysis, the variables which were directly associated with exclusive breastfeeding, with 0.05 significance level of alpha, included breastfeeding within the first hour of birth, eight times or more breastfeeding per day and receiving breastfeeding education during pregnancy. Variables with a negative association with breastfeeding included lack of breast milk, presence of a breast problem that could hinder breastfeeding, bottle feeding, physician or family's advice not to breastfeed and infant's refusal to breastfeed. Frequency of breastfeeding within the six months of birth is less than similar frequencies which are obtained by asking about breastfeeding on the day of the interview. It is recommended to apply real frequency for assessment, evaluation and programming of exclusive breastfeeding during the first six months of birth. https://acta.tums.ac.ir/index.php/acta/article/view/4577 https://acta.tums.ac.ir/index.php/acta/article/download/4577/4512

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 52 7 2014 07 15 557 561 EN Ali Labaf Department of Emergency Medicine, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Kazem Jamali Department of Emergency Medicine, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. Mohammad Jalili Department of Emergency Medicine, Center for Educational Research in Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran. Hamid R Baradaran Center for Educational Research in Medical Sciences, Iran University of Medical Sciences, Tehran, Iran. Parisa Eizadi Department of Emergency Medicine, Imam Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 11 To evaluate the effect of frequent feedback on residents' communication skills as measured by a standardized checklist. Five medical students were recruited in order to assess twelve emergency medicine residents' communication skills during a one-year period. Students employed a modified checklist based on Calgary-Cambridge observation guide. The checklist was designed by faculty members of Tehran University of Medical Science, used for assessment of students' communication skills. 24 items from 71 items of observational guide were selected, considering study setting and objects. Every two months an expert faculty, based on descriptive results of observation, gave structured feedback to each resident during a 15-minute private session. Total mean score for baseline observation standing at 20.58 was increased significantly to 28.75 after feedbacks. Results markedly improved on "gathering information" (T1=5.5, T6=8.33, P=0.001), "building relationship" (T1=1.5, T6=4.25, P<0.001) and "closing the session" (T1=0.75, T6=2.5, P=0.001) and it mildly dropped on "understanding patients view" (T1=3, T6=2.33, P=0.007) and "providing structure" (T1=4.17, T6=4.00, P=0.034). Changes in result of "initiating the session" and "explanation and planning" dimensions are not statically significant (P=0.159, P=0.415 respectively). Frequent feedback provided by faculty member can improve residents' communication skills. Feedback can affect communication skills educational programs, and it can be more effective if it is combined with other educational methods. https://acta.tums.ac.ir/index.php/acta/article/view/4576 https://acta.tums.ac.ir/index.php/acta/article/download/4576/4514

Tehran University of M