Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 11 2016 12 14 743 749 EN Abdolhossein Emami Sigaroudi Department of Medical Educations, Medical Education Research Center, Guilan University of Medical Sciences, Rasht, Iran. AND Department of Nursing, School of Nursing, Guilan University of Medical Sciences, Rasht, Iran. Shahrzad Ghiyasvandian Department of Nursing, School of Nursing, Tehran University of Medical Sciences, Tehran, Iran. Alireza Nikbakht Nasabadi Department of Nursing, School of Nursing, Tehran University of Medical Sciences, Tehran, Iran. 2016 01 05 2016 06 18 The concept of blended learning in the field of nursing and medicine has been accepted. Blended learning has been extensively used thanks to the development of communication technologies and the availability of Internet services. Meanwhile, experiences-based research, by all accounts, can help the expansion of such a learning modality. Therefore, this study was designed to explain nursing doctoral students’ experiences of blended learning. To attain this goal, a descriptive phenomenology method was used to illustrate experiences as they are experienced by the participants in the study. With regard to the nature of the investigated phenomena and the existing methods for the inductive analysis, Colaizzi’s method of data analysis was used. The findings of the study led to the discovery of three main themes: "failure", "synergy" and "specific interaction". Each of the themes has been further divided into some sub-themes. https://acta.tums.ac.ir/index.php/acta/article/view/5343 https://acta.tums.ac.ir/index.php/acta/article/download/5343/4864

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 11 2016 12 14 750 753 EN Seyed Ali Dehghan Manshadi Department of Infectious and Tropical Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Omid Rezahosseini Department of Infectious and Tropical Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Zahra Abdi Liaei Department of Infectious and Tropical Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2015 11 18 2016 03 04 The brucellosis with multi-organ involvement in a patient with a history of the composite aortic graft (Bentall procedure) and Hepatitis B infection is rare. A 35-year-old man presented to us with fever and loss of consciousness. Four years ago, he was IDU and underwent cardiac surgery because of endocarditis. Recently lumbar spondylodiscitis was diagnosed. The Wright (1/320) and Coombs Wright tests (1/640) were positive. After CNS imaging, lumbar puncture was done. The CSF pleocytosis was lymphocyte dominant. In cardiac echocardiography, large vegetation on prosthetic aortic valve leaflets was seen. The brain MRI was reported abnormal. Treatment of brucellosis started with Ceftriaxone, Doxycycline, Rifampin and Gentamycin. After 4 days, he became oriented, and fever was disappeared then we continued the treatment for 16 days. The patient discharged and followed by daily phone calls. As symptoms of abdominal pain and jaundice were presented on the fifth day, he re-admitted. The patient expired because of hepatorenal and cardiac insufficiency. Drug side effects, activation of Hepatitis B and embolism of cardiac vegetation to other organs were suspected causes of death. We do not suggest medical therapy without cardiac surgery in such cases. When combination therapy is necessary for brucellosis in an HBsAg-positive patient, hepatitis virus activity should be assess by HBV-DNA PCR and the dose of drugs with known hepatotoxic effects such as rifampin and co-trimoxazole should be adjust. Combination therapy with quinolones instead of hepatoxic drugs is one of our suggustions. https://acta.tums.ac.ir/index.php/acta/article/view/5158 https://acta.tums.ac.ir/index.php/acta/article/download/5158/4865

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 11 2016 12 14 690 695 EN Shadi Kolahdoozan Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. Sadegh Massarrat Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 2016 12 12 2016 12 12   The indexed Iranian journals in ISI and PubMed at the end of 2012 with known impact factor (IF) were evaluated with regard to the number of articles published in 2010-2012, the number of citations by authors from inside and outside Iran, their IF as well as their ranking order among all other journals in their specialized categories. There were among 130 English journals, 21 indexed with known IF. The mean IF of these journals increased from 0.4 in 2010 to 0.68 in 2012. The number of citations per article by authors from outside Iran increased from 0.19 to 0.49 during the same time period. The rank of the majority of the indexed journals was in the lowest 20% of their category. Although some improvement has been observed in the quality and the number of citations of Iranian journals indexed in ISI during these two years, the quality of the manuscripts remains low. A reduction in the number of journals, a change of their structure as well as more financial resources for research is necessary for the improvement of the quality and better rank and status of Iranian science among an international audience. https://acta.tums.ac.ir/index.php/acta/article/view/6057 https://acta.tums.ac.ir/index.php/acta/article/download/6057/4867

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 11 2016 12 24 696 703 EN Ahmad Fakhri Department of Psychiatry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Sirous Pakseresht Department of Psychiatry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Mohammad Reza Haghdoost Department of Psychiatry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Nasihat Hekmatkhah Department of Psychiatry, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Maria Torkashvand Department of Internal Medicine, School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Behnam Ghorbanzadeh Department of Pharmacology, School of Medicine, Dezful University of Medical Sciences, Dezful, Iran. 2015 11 01 2016 08 14 Glutamate dysregulation may be involved in the neuropathology of schizophrenia. Memantine, a drug approved by the FDA for the treatment of moderate to severe Alzheimer's disease, acts as a partial uncompetitive NMDA receptor antagonist. The aim of this study was to examine the efficacy of memantine as an adjunctive treatment to olanzapine in patients with schizophrenia. In this double-blind, placebo-controlled studies, patients with schizophrenia according to DSM-IV clinical criteria were selected. Patients were randomly assigned to receive either memantine (week 1:10 mg/day; weeks 2-6:20 mg/day) plus olanzapine (15-20 mg/day) or olanzapine plus placebo. At baseline, no statistically significant difference regarding the mean total PANSS scores between treatment groups was found. Results showed that memantine significantly improved the positive and negative PANSS score in patients maintained on olanzapine after six weeks compared to olanzapine alone (P<0.001). Furthermore, female patients showed significantly better response than males, especially in positive PANSS score. No significant changes in extrapyramidal symptoms were observed.These findings indicate that olanzapine efficacy might be augmented with memantine. Furthermore, this effect is more remarkable in female patients with schizophrenia. https://acta.tums.ac.ir/index.php/acta/article/view/5105 https://acta.tums.ac.ir/index.php/acta/article/download/5105/4870

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 11 2016 12 14 754 755 EN Seyed Mohammadreza Rabani Department of Urology, Shahid Beheshti Teaching Hospital, Yasuj University of Medical Sciences, Yasuj, Iran. 2015 10 20 2015 10 20 Giant or massive bladder stone is a rare condition that is usually seen in men with an underlying urologic problem. Hereby we report a large stone in a healthy young female without any predisposing factor and with the minimal urologic complaint. https://acta.tums.ac.ir/index.php/acta/article/view/5015 https://acta.tums.ac.ir/index.php/acta/article/download/5015/4687

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 11 2016 12 14 704 708 EN Heshmat Shahi Department of Immunology, Cellular and Molecular Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. Rasoul Bahreiny Department of Internal Medicine, School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran. Somayeh Reiisi Department of Genetics, School of Basic Sciences, Shahrekoed University, Shahrekord, Iran. 2016 04 28 2016 08 01 Helicobacter Pylori infection is a common gastrointestinal infection that can cause pathological effects, increase oxidative stress and induce an inflammatory response in gastric mucosa. Inflammatory aspects may prompt the production of radical oxygen substance (ROS) which may damage cells and release 8-hydroxydyoxyguanosine (8-OHdG) to serum. In this study, we evaluate the prevalence of H. pylori virulence factors and the association between serum level of 8-OHdG, H. pylori infection, and its various virulence factors. The presence of H. pylori and prevalence of cagA, babA and oipA genes in samples were determined by rapid urease test (RUT), histopathological exam (HE) and polymerase chain reaction (PCR) and oxidative DNA damage situation were assessed by using serum level of 8-OHdG. There was not any direct relation between H. pylori negative and H. pylori oipA+specimens by 8-OHdG serum level (P>0.05). In all clinical observations, the presence of cagA and oipA genes was common. There was a statistical relationship between the presence of cagA, babA factors, and high serum level of 8-OHdG (P<0.05). The presence of cagA and babA virulence factors may be associated with increased serum 8-OHdG in dyspeptic patients and may induce the damage to gastric cells. https://acta.tums.ac.ir/index.php/acta/article/view/5601 https://acta.tums.ac.ir/index.php/acta/article/download/5601/4869

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 11 2016 12 14 709 712 EN Atossa Mahdavi Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Zeinab Telkabadi Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ashraf Aleyasin Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Marzieh Agha Hosseini Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Leili Safdarian Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. Ali Momenzadeh Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran. 2016 01 24 2016 02 28 This study investigated efficacy and side effects of Morphine suppository for pain management after the first elective caesarean delivery in comparison to Diclofenac suppository. One hundred women aged 18-40 with term pregnancies undergoing elective caesarean section for the first time participated in this prospective project. Exclusion criteria included drug sensitivity, fetal malformations or defects, and complications during the cesarean operation. After same spinal anesthesia and same surgical techniques and in the recovery room patients consecutively received 100 mg diclofenac suppository or 10 mg morphine suppository. The pain severity was rated by “Numerical Rating Scale.” There was not the difference between two groups in terms of basal information. Pain score was significantly different between two groups in the first 12 hours (5.66 ±1.36 in morphine group and 3.63±0.96 in diclofenac group) but not in the second 12 hour period. Considering pain scores every two hours in first 12 hours and every 4 hours in second 12 hours, morphine group had higher scores in comparison to diclofenac group. Also, the morphine group required pethidine injection sooner than the other group. The time giving first pethidine injection was 3.28±2.16 hours after operation in morphine group and 5.24±4.07 hours after operation (P<0.05). This study demonstrated that diclofenac suppository in comparison to morphine suppository decreased subjective pain scores in the first twenty-four hours after elective caesarean section which reached statistical significance in the first twelve hours. Although in diclofenac group, pethidine injection was prescribed significantly later. https://acta.tums.ac.ir/index.php/acta/article/view/5400 https://acta.tums.ac.ir/index.php/acta/article/download/5400/4859

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 11 2016 12 14 713 717 EN Soraya Saleh Gargari Department of Obstetrics and Gynecology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. AND Infertility and Reproductive Health Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Zahra Seify Department of Obstetrics and Gynecology, Mahdiyeh Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Ladan Haghighi Department of Obstetrics and Gynecology, Akbarabadi Hospital, Iran University of Medical Sciences, Tehran, Iran. Maryam Khoshnood ShariatiLegal Medicine Research Center, Legal Medicine Organization, Tehran, Iran. 2016 06 25 2016 06 26 A 40-year-old male patient with suicidal ingestion of one tablet of aluminium phosphide was referred to the department of toxicology emergency of Baharloo Hospital, Tehran, Iran. The garlic odor was smelled from the patient and abdominal pain and continuous vomiting as well as agitation and heartburn were the first signs and symptoms. Systolic and diastolic blood pressures at the arrival time were 95 and 67 mmHg, respectively. Gastric lavage with potassium permanganate (1:10,000), and 2 vials of sodium bicarbonate through a nasogastric tube was started for the patient and the management was continued with free intravenous infusion of 1 liter of NaCl 0.9% serum plus NaHCO3, hydrocortisone acetate (200 mg), calcium gluconate (1 g) and magnesium sulfate (1 g). Regarding the large intravenous fluid therapy and vasoconstrictor administering (norepinephrine started by 5 µg/min and continued till 15 µg/min), there were no signs of response and the systolic blood pressure was 49 mmHg. At this time, hydroxyethyl starch (HES) (6% hetastarch 600/0.75 in 0.9% sodium chloride) with a dose of 600 cc in 6 hours was started for the patient. At the end of therapy with HES, the patient was stable with systolic and diastolic blood pressure of 110 and 77 mmHg, respectively. He was discharged on the 6th day after the psychological consultation, with normal clinical and paraclinical examinations. This is the first report of using HES in the management of AlP poisoning and its benefit to survive the patient. https://acta.tums.ac.ir/index.php/acta/article/view/5737 https://acta.tums.ac.ir/index.php/acta/article/download/5737/4819

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 430 436 EN Ali Hassanpour-Dehkordi Department of Medical Surgical, Nursing and Midwifery Community-Oriented (Holistic) Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran. Amir Jalali Department of Psychiatric Nursing, Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran. 2015 10 19 2016 03 04 Since the elderly population is increasing rapidly in developing countries which may decrease the physical activity and exercise and in turn could affect the elderly’s quality of life, this study aimed to investigate the effect of progressive muscle relaxation on the elderly’s quality of life in Iran. In a randomized clinical trial, participants were randomly divided into intervention and control groups. For the intervention group, muscular progressive relaxation was run three days per week for three months (totally 36 sessions). In relaxation, a patient contract a group of his/her muscles in each step and relaxes them after five seconds and finally loosens all muscles and takes five deep breaths. Each session lasts for 45 minutes. The instrument of data gathering consisted of questionnaires on individual’s demographic data and quality of life SF-36. After intervention, quality of life increased significantly in the patients undergoing muscular progressive relaxation and fatigue severity decreased significantly in the intervention group compared to prior to intervention. In addition, there was a statistically significant difference in mean score of physical performance, restricted activity after physical problem, energy, socially function, physical pain, overall hygiene, and quality of life between intervention and control groups. By implementing regular and continuous progressive muscle relaxation, quality of life could be increased in different dimensions in the elderly and the context could be provided to age healthily and enjoy higher health and autonomy. Therefore, all of the therapeutic staffs are recommended to implement this plan to promote the elderly’s quality of life. https://acta.tums.ac.ir/index.php/acta/article/view/5009 https://acta.tums.ac.ir/index.php/acta/article/download/5009/4810

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 437 440 EN Mohammad Reza Motie Department of General Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. Parham Hashemi Department of General Surgery, Surgical Oncology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran. 2015 10 19 2016 04 05 To determine whether the medical Treatment of anal fissure can be an effective alternative for surgery Methods: Retrospectively, we randomly selected 190 Patients being treated for anal fissure between the years 2005-2010 in 3 equal groups: group A: Patients who received medical treatment with topical nitroglycerin, group B: Patient treated with topical diltiazem, and group C: Patients underwent surgery. The results were then correlated with the statistical program SPSS using chi-square test. Main complaints of the patients were first anal pain and then bleeding. The response to treatments for relieving pain was: 77% in A, 83% in B, and 98% in group C. Response of treatments for fissure healing, in order of groups A, B and C was: 74%, 83%, and 94%. Despite good response to medical treatment, surgical treatment was more effective and medical treatment of choice in patients who are willing to have surgery. https://acta.tums.ac.ir/index.php/acta/article/view/5005 https://acta.tums.ac.ir/index.php/acta/article/download/5005/4811

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 441 447 EN Mehran Maghsoudloo National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. Farid Abolhassani National Institute of Health Research, Tehran University of Medical Sciences, Tehran, Iran. Nasrin Lotfibakhshaiesh School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran. 2015 10 10 2016 03 27 The collection of data within the primary health care facilities in Iran is essentially paper-based. It is focused on family’s health, monitoring of non-infectious and infectious diseases. Clearly due to the paper-based nature of the tasks, timely decision making at most can be difficult if not impossible. As part of an on-going electronic health record implementation project at Tehran University of Medical Sciences, for the first time in the region, based on a comprehensive pilot project, four urban healthcare facilities are connected to their headquarters and beyond, covering all aspects of primary health care, for the last four years. Without delving into the technical aspects of its software engineering processes, the progress of the implementation is reported, selection of summarized data is presented, and experience gained thus far are discussed. Four years passed and if time is any important reason to go by, then it is safe to accept that the software architecture and electronic health record structural model implemented are robust and yet extensible. Aims and duration of a pilot study should be clearly defined prior to start and managed till its completion. Resistance to change and particularly to information technology, apart from its technical aspects, is also based on human factors. https://acta.tums.ac.ir/index.php/acta/article/view/4305 https://acta.tums.ac.ir/index.php/acta/article/download/4305/4812

Tehran University of Medical Sciences Acta Medica Iranica 0044-6025 54 7 2016 07 09 448 453 EN Asghar Hajiabbasi Guilan Rheumatology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran. Irandokht Shenavar Masooleh Guilan Rheumatology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran. Yousef Alizadeh Guilan Eye Research Center, Amir Almomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran. Amir Sadredin Banikarimi Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran. Pooneh Ghavidel Parsa Guilan Rheumatology Research Center, Razi Hospital, Guilan University of Medical Sciences, Rasht, Iran. 2015 10 20 2016 03 04 Sjogren syndrome (SS) can occur alone, primary Sjogren syndrome, or in association with other rheumatic diseases, secondary Sjogren syndrome (sSS), such as Rheumatoid arthritis (RA). The occurrence of Sjogren syndrome with RA makes it course worse and increases high morbidity and mortality of RA. In this exploratory study we aim to determine the prevalence of sSS (diagnosed based on the revised version of American–European consensus Group Classification Criteria: AUCG-criteria), sicca symptoms (dry eye, dry mouth), positive autoantibody tests (Anti RO or Anti-LA antibodies), UWSFR (Unstimulated Whole Salivary Flow Rate), Schirmer and Lissamine test. In this cross-sectional study, eighty three consecutive RA patients (according to American College of Rheumatology criteria 1987) who were visited at rheumatology clinic of Razi General Hospital located in the north of Iran entered into our study. Our exclusion criteria was a positive history of past head and neck radiation treatment, Hepatitis C infection, acquired immunodeficiency disease (AIDS), pre-existing lymphoma, sarcoidosis, graft versus host disease, use of anticholinergic drugs (including neuroleptics, antidepressants, antihypertensive and parasympatholytics). They examined with UWSFR by a rheumatologist and with Schirmer test and Lissamine test by an ophthalmologist. Participants were 90.4% female with the mean age 48.3±13 years. Duration of RA was in 36.1% less than 5 years, in 22.9% 5-10 years, in 12.1% 11-15 years and in 28.9% more than 15 years. Our results demonstrated that the prevalence of sSS was 5.9% (CI:0.6%-10.5%). Number of 27.7% of RA patients positively responded to at least one question about sicca symptoms. Among objective tests, only Positive UWSFR and Lissamine test were significantly more common in RA patients with sSS in comparison to ones without sSS (P<0.001, P=0.01 respectively). In RA patients, we found a linear trend between sicca symptoms and aging (P=0.02). In patients with sicca symptoms, among tests that used for assessing decrease in saliva or tear production, only USWFR significantly more common (P=0.01). In conclusion: In RA population in North of Iran prevalence of sSS was less than 10%. In them, a significant linear trend existed between aging and sicca symptoms. Among objective tests of AUCG-criteria (except for lip biopsy that was not performed in the current study) only UWSFR and Lissamine test were significantly more common in patients with sSS in comparison ones without it. https://acta.tums.ac.ir/index.php/acta/article/view/5006 https://acta.tums.ac.ir/indexences, Qazvin, Iran. Ezzatossadat Haj Seyed javadi Department of Gynecology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. 2015 10 06 2015 10 06 The use of corticosteroids is one of the methods put forward for the strengthening and speeding up the process of labor. After identification of glucocorticoid receptors in human amnion, the role of corticosteroids in starting the process of labor has been studied in numerous studies.The purpose of this study was to determine the effect of intravenous Dexamethasone on preparing the cervix and on labor induction. A randomized, clinical, and double – blind trial was conducted on 172 women divided into a control and an experimental group. The inclusion criteria were that they had to be primparous, in or before the 40 the week of pregnancy, and with Bishop scores (B.S.s) of 4 or lower. The exclusion criteria were diabetes, preeclampsia, macrosomia, twin pregnancy, rupture of the membrane (ROM), breech, and women suffering from background diseases. The B.S.s of the women was measured in charge of the study, and each woman was intravenously injected with eight milligrams of Dexamethasone or eight milligrams of distilled water. Four hours after the injections, the B.S.s of the participants was measured, and they were put under the conditions of labor induction using oxytocin. Information was collected in checklists A and B. The patients were compared with respect to B.S., the time the induction started, the average interval between the start of induction and the beginning of the active phase of childbirth, and the average length of time between the start of the active phase and the second stage of childbirth.The first and five minutes Apgar scores of the two groups of women were compared. The frequencies, the means, and the standard deviations were calculated using the SPSS – 16 software, and analysis of the results was performed with the Student’s t- test and the chi-square test with P<0.05. There were no statistically significant differences between the two groups in terms of their age, period of pregnancy, and B.S. at the start of the study. The average B.S. of women f