مجله دانشکده پزشکی اصفهان
پیاپی 453 (هفته اول دی 1396)

Electronic medical record system is one of the most important subsystems of hospital information system. The system improves the accuracy of documentation, and patient and physician access at any time and place, and reduces medical errors, and quality of patient care. This study aimed to rank electronic medical record system in hospital information systems of teaching hospitals in Isfahan University of Medical Sciences, Iran, in 2016.
This was an applied cross-sectional and analytical study. The statistical population consisted of 8 users of the electronic medical record subsystem, and hospital information systems in the first and second stage, respectively. A questionnaire was prepared based on the checklist of evaluation indicators of the hospital information systems of Iranian Ministry of Health and Medical Education, and 16 items related to electronic medical record subsystem were weighted from the physician' point of view using analytical hierarchy process in Excel software. In the next stage, Sayan Ryan, Pouya Samaneh, Kowsar, and Rayavaran were ranked and scores were determined using simple additive weighting method.
Findings: The compliance with this subsystem in the health information system was 100.00, 84.81, 78.49, and 28.33 percent for Kowsar, Sayan Ryan, Rayavaran, and Pouya Samaneh, respectively.
Kowsar subsystem of electronic medical record, with respect to the evaluation indicators, ranked first and Pouya Samane was the last. Weighting the evaluation checklist of Iranian Ministry of Health and Medical Education with a user-centric approach is one of the achievements of this study, which allows for more realistic ranking of hospital information systems.

This study aimed to compare premedication with sodium thiopental, magnesium sulfate, midazolam, prime etomidate dosage, remifentanil, and normal saline on decreasing myoclonus incidence and pain induced by anesthesia with etomidate.
In a clinical trial study, 162 patients who were candidates for anesthesia were randomly entered in 6 equal groups. Two minutes before induction of anesthesia, patients were treated with intravenous thiopental, magnesium sulfate, midazolam, remifentanil, prime etomidate dosage, or normal saline. Pain, myoclonus, and complications were determined and compared between the groups.
Findings: Intensity of myoclonus was not significantly different between the six groups at zero, 10, and 15 minutes after anesthesia. But at 5th minute, midazolam (0.51) and fentanyl (0.81) groups had the lowest and magnesium sulfate (1.88) and prime etomidate dosage (1.77) groups had the highest myoclonus; the difference between the groups was significant (P = 0.002).
It seems that administration of midazolam with etomidate is the best choice for anesthesia. Therefore, it is recommended that this drug be used in combination with etomidate to induce anesthesia in patients. More studies are recommended.

The prevalence of obesity is increasing around the world. Although bariatric surgery is the most effective treatment for obesity, patients undergoing bariatric surgery still face with a great number of complications. In this study, we sought to determine short-term outcomes of bariatric surgery in patients with obesity.
59 patients with body mass index (BMI) of 40 kg/m2 or more, who underwent bariatric surgery, were enrolled this study. Clinical outcomes were retrospectively obtained.
Findings: 9 patients (15%) had gastrointestinal leak, 14 patients (24%) had major bleeding, and 4 (7%) faced with infection. From 24 patients (41%) admitted in intensive care unit, 23 patients discharged without any complication and 1 died.
There is no standard guideline to decrease complications in bariatric surgery. Further prospective studies with greater sample sizes and surveying long-term outcomes are needed to establish this guideline.

Mucormycosis is a rare disease with high mortality rate, especially in immunocompromised patients such as patients with diabetes. This study aimed to evaluate the prevalence of mucormycosis and its association with mortality rate in patients admitted to Alzahra hospital, Isfahan, Iran.
55 patients with symptomatic and definitive diagnosis of mucormycosis were enrolled in this retrospective cross-sectional study. Mortality risk factors were evaluated and compared between the dead and survived patients.
Findings: Mortality rate was 29.09 percent among the patients and there was a significant relationship between the involved location and the mortality rate (P = 0.02). In addition, the mortality rate was 100% in patients with disseminated infections.
The mortality rate in patients with mucormycosis admitted to Alzahra hospital was lower than the rates reported by other studies.

Using ionizing radiation in diagnosis and treatment is of great importance. As early diagnosis in some diseases only can be done by using radiation, in treatment phase, radiotherapy is also the main center for healing patients with cancer. Today, one of occupational hazards is ionizing radiation which can cause serious and irreparable damages in radiation workers. This study aimed to count blood cells and evaluate liver enzymes and thyroid-stimulating hormone (TSH) in radiation workers in hospitals in Kurdistan Province, Iran.
In this case-control study, blood cells, liver enzymes, and TSH levels were compared in 142 radiation staff (cases) and also 142 workers in other sections of hospitals. Matching was done for confounding factors. The statistical analysis was performed using SPSS software at the significance level of P Findings: Mean number of white blood cells and the level of serum alanine aminotransferase (ALT) enzyme in radiation staff were significantly different from that of the control group. But no significant difference was observed between other parameters.
It seems that working in radiation wards can change some blood factors but can not predict the recieved dose. In order to increase the safety of radiation workers in radiation wards, monitoring of these individuals should be done annually using cytogenetic methods.

Cartilage tissue is avascular and has no repairing capacity. For cartilage tissue engineering, stem cells and growth factors are used. In this study, the effect of pomegranate as inducer for chondrogenesis of adipose-derived stem cells (ADSCs) was evaluated.
Human adipose-derived stem cells in third passage seeded in fibrin were cultured in chondrogenic medium with pomegranate for 2 weeks. 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT assay) and western blot technique were applied for evaluation of differentiated cells.
Findings: Adipose-derived stem cells differentiated into chondrocytes; and type II collagen production by differentiated cells was proved.
Pomegranate extract is an appropriate inducer for production of type II collagen in adipose-derived stem cells.

Cervical pregnancy is a rare life threatening form of ectopic pregnancy. This is a case report of cervical pregnancy.
Case Report: We describe a case of cervical pregnancy early diagnosed via transvaginal ultrasound and magnetic resonance imaging (MRI). She was treated through curettage, ligation of descending branch of uterine vessels, and tamponade following treatment failure using methotrexate (MTX) due to the patient's refuse to continue treatment; her fertility was preserved, too.
Early diagnosis via vaginal ultrasonography and confirmation of magnetic resonance imaging, and using nonsurgical conservative treatment methods such as methotrexate, ligation of uterine vessels, and cervical tamponade, to preserve the fertility, are the first actions in cervical pregnancy.