مجله دانشکده پزشکی دانشگاه علوم پزشکی تهران
سال هفتاد و پنجم شماره 8 (پیاپی 200، آبان 1396)

Today, the use of information and communication technology (ICT) is an important and key factor in the progress of all organizations, including health-centered and health systems. Given the importance of the subject matter above, these organizations have created a particular transformation and change in order to upgrade their systems in use, one of which is the creation of Electronic Health Records (EHR). This evolving system, by increasing productivity, both by increasing staffing efficiency and by increasing the effectiveness of the treatment process, simplifies the diagnosis path to treatment and prevents the submission of written and bulky reports. Given the ethical principles of protecting the privacy of patients and the confidentiality of their information, how to archive electronic medical records in a secure database is very important. This is one of the most important issues of ethics and hospital managers should provide mechanisms to keep all patient data properly stored and maintained. In this paper, we have tried to provide a model for the Electronic Health Record Hospital, which many of them could use to optimize their medical records systems. The purpose of this model is to accelerate and apply the process of creating electronic records in the health system, especially government hospitals with a large number of patients. By using this model, internal and external interaction of organization is facilitated, and agile responsiveness can be provided at a given time. In addition to the above, with the implementation and operationalization of the model, the possibility of reducing the volume of criticisms and complaints from hospitals will also be realized and the use of drugs will be based on the actual needs of the community and based on individual data. Implementation of this model also has barriers to addressing some of them in this article, but in order to overcome these barriers, more administrative effort and wider governmental support are needed. These efforts in the context of culture-building use of information technology, both among hospital personnel and among patients and healthcare users, are more important.

Historically, tuberculosis has been the leading cause of death throughout human history. Tuberculosis infection (TB) causes by Mycobacterium tuberculosis that is very dangerous and can affect any parts of the body, especially lungs. Tuberculosis infection still remains a serious threat to human public health due to its contagious nature, capability to stay latent form in host for indefinite time and then appear as active disease. It is estimated that one third of world’s population, nearly 2 billion persons are infected with Mycobacterium tuberculosis. Transmission occurs among people through inhalation of infected droplets. Lungs and especially alveolar macrophage are primary sites of infection. Mycobacterium tuberculosis bacilli by preventing fusion of phagosome with lysosome can remain alive inside the macrophages. Such situation defined as latent infection. In fact, persons with latent tuberculosis infection (LTBI) are only infected with M. tuberculosis without any sign of infectious. Latent infection in compared with active infection is not contagious, but in about 10-5 percent of people will develop active tuberculosis especially in elderly and people who use immunosuppressive drugs. Pulmonary TB is an active form of tuberculosis infection in which bacteria can spread among people by infected droplets. So identifying and treating people with latent TB infection can significantly reduce the progression of latent form to active infection. The tuberculin skin test (TST) is the most widely used test in worldwide that is applied to determine a person who is infected with M. tuberculosis. TST provide valubale information for diagnosis LTBI however its specificity can be reduced by bacillus Calmette-Guérin (BCG) vaccination and infected with non-tuberculous mycobacteria (NTM). In TST test host hypersensitivity responses to Purified protein derivative (PPD) from mycobacterium are evaluated. TST positive reaction indicates the presence of high risk for acquiring TB infection or progression of latent tuberculosis to active form. Previous studies indicated that there is correlation between TST response and subsequent risk of active TB. Experimental evidence has shown that treatment of latent infection in the basis of positive TST reduces the risk of active TB. Although TST is far from gold standard but it's low cost and simplicity make it a suitable laboratory test especially in developing country.

Nanoparticles are particles that have at least one dimension between 1 and 100 nanometers. Nanoparticles are a new generation of antimicrobial agents. Nanoparticles with antimicrobial activity, especially as a new class of biomedical materials for use in increasing the level of public health in daily life have emerged. Zinc oxide nanoparticles have attracted a great attention due to the variety of their applications in medical science. The aim of this study was to evaluate and compare the antimicrobial activity of zinc oxide nanoparticles synthesized by green method.
This experimental study was done in 2017, from March to September in the Bam Research Center of University of Medical Sciences Kerman, Iran. Green synthesis of zinc oxide nanoparticles was investigated using cumin seeds. The physicochemical characteristics of synthesized nanoparticles were studied by UV-visible ultraviolet spectrometer (Analytik Jena AG, Germany), X-ray diffraction and transmission electron microscope (TEM) (Carl Zeiss, Germany). Broth microdilution method was used to investigate the antimicrobial activity of zinc oxide nanoparticles. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of these nanoparticles were determined for Pseudomonas aerogenes and Enterococcus faecalis strains.
The UV-visible ultraviolet spectroscopy showed an absorption peak in the range of 370 nm. Transmission electron microscopy shows the synthesis of zinc oxide nanoparticles, mostly spherical, with a size less than 50 nm. Minimum inhibitory concentration of zinc oxide nanoparticles against P. aerogenes and E. faecalis strains was determined at 6.25 and 12.5 μg/ml, respectively. Both bacteria were sensitive to zinc oxide nanoparticles. This sensitivity was higher for gram-negative bacteria.
Zinc oxide nanoparticles were produced using Iranian natural resources and our results showed significant antibacterial activity. Nanotechnology creates materials with novel properties every day, and creates new hope for improving environmental pollution. These nanoparticles can be used as a new generation of antimicrobial agents in various medical disciplines. For example, toothpaste containing zinc nanoparticles can be produced and prescribed for patients with immune deficiency to prevent the growth of microbial pathogens in the mouth and its transmission to the patient's body.

Endometrial cancer (EC) is the most prevalent genital related cancer of females. One of the controversial points about endometrial cancer surgery is preserving or dissection of sentinel lymph nodes (SLNs). Lymphatic mapping and sentinel nodes sample has been used widely for diverse solid tumors in order of finding metastasis in lymph nodes. The aim of current study was to evaluate diagnostic value of technetium-99 and methylene blue in diagnosis of sentinel lymph node involvement in low-risk endometrial cancer.
This cross-sectional study was conducted through 2016 on 14 patients with low-grade endometrial cancer referred to Al-Zahra and Shahid Beheshti Hospitals (affiliated to Isfahan University of Medical Sciences), Iran, in 2016-17. Eighteen and twenty-four hours before operation, patients underwent technetium-99 (Tc-99) injection to uterine cervix. Twenty-four hours prior to surgery, patients were referred to resident of gynecology and filled demographic checklist. In next day during operation, Tc-99 was detected by gamma probe. Methylene blue was injected in operation room and blue nodes were detected by naked eye. All patients underwent total hysterectomy, bilateral salpingo-oophorectomy and pelvic lymphadenectomy. Dissected lymph nodes were sent for frozen section and assessment of positive/negative metastasis. Then data were analyzed with SPSS software, version 20 (SPSS Inc., Chicago, IL, USA).
Mean age of our patients was 60.64±9.18 years. Total number of 80 SLNs was dissected. 18.8% of nodes were detected using methylene blue, 12.5% using tecnethium-99 and 6.3% were in common with both methods. Number of two nodes was metastatic and was detected by blue dye and Tc-99. Sensitivity, negative predictive value and detection rate of Tc-99 alone, methylene blue alone and their combination was 100% and false negativity of all above was 100%.
Due to findings of our study, as sensitivity, detection rate, negative predictive value and false negativity of methods lonely and in combination were similar thus based on higher probability of blue dye adverse effects, use of Tc-99 lonely may be adequate.

Gastroesophageal reflux is a common condition among premature infants, which causes problems such as reduced weight gain and prolonged length of hospital stay. Body status is an appropriate way to reduce this condition. However, there have been few studies conducted in this regard. The objective of this study was therefore to investigate the effect of body status on gastroesophageal reflux in premature infants.
The present research was a crossover study conducted on premature infants with a gestational age of 33-36 weeks in Al-Zahra Hospital in Tabriz, Iran, from January to March 2015. In this clinical trial, thirty-two premature infants hospitalized in this center were selected as the sample. The initial selection of the participants was based on the simple random sampling. Then the participants were allocated to groups using randomized block procedure. Each infant was under study for 4 days. After each feeding and about two hours before the beginning of next feeding, the infants were randomly and not repeatedly put in one of the following four status for 12 hours (8 am -8 pm) every day: facilitated fetal tucking posture in lateral position, free body posture in lateral position, facilitated fetal tucking posture in supine position, and free body posture in supine position. Then, the incidence of gastroesophageal reflux was measured in each of these statuses. SPSS software, version 21 (SPSS Inc., Chicago, IL, USA) was used to analyze the data at significant level of P The results showed that there was a significant difference between facilitated fetal tucking posture in lateral position and other status (P The findings of this study revealed that facilitated fetal tucking posture and lateral positioning reduced the incidence of gastroesophageal reflux in hospitalized premature infants.

Each year, Human influenza A (H1N1) virus causes moderate to severe infections with a high prevalence throughout the world. Accordingly, the rapid, sensitive and cost-effective laboratory diagnosis based on viral antigen detection is important. Moreover, the generation of specific antibodies directed against Influenza antigens is essential to the success of both basic and applied research programs. Hemagglutinin (HA) is the major surface envelope glycoprotein of influenza virus, which is subsequently cleaved into two subunits, HA1 and HA2. Since most antigenic sites are in the HA1 domain of HA, HA1 domain of influenza virus was studied as antigen to produce polyclonal antibody.
In this experimental study we expressed and purified the recombinant HA1 protein in the second half of 2015 at department of influenza and other respiratory viruses, Pasteur Institute of Iran and then prepared the polyclonal rabbit antibody against it. The vector of pET28aHA1 expressing HA1-His tagged protein of H1N1 influenza A/PR/8/34 virus was used for large scale production of HA1 into E. Coli (BL21). By changing expression conditions such as IPTG (Isopropyl β-D-1-thiogalactopyranoside) concentration, time and temperature of incubation, the expression conditions for HA1 were optimized. The total cell protein harvested and purified by nickel affinity chromatography. All above mentioned experiments monitored by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE).
The efficiency of HA1 recombinant protein was high, equal to 400-600 mg/ml of cell lysate. The polyclonal antibody was prepared by immunizing the rabbits using recombinant HA1 with Freund’s adjuvant according to standard protocols. Efficiency of the antiserum evaluated by enzyme linked immunosorbent assay (ELISA). Determination of antibody level in the collected antiserum using serum-based ELISA showed that the specific antibody has risen well through the immunization schedule.
Our data shows that this polyclonal antibody has potential to be produced in rabbit. It will also be used in the future in influenza diagnosis as well as in other immunological applications such as western blot analyses, immunocytochemistry, and immunohistochemistry.

Multiple sclerosis (MS) is one of the most common chronic diseases creating major psychological challenges. Hence, the purpose of this study was to investigate the effectiveness of cognitive-behavioral therapy (CBT) on mental toughness and life expectancy of MS patients.
The design of this quasi-experimental study has been with pre-test, post-test and follow-up with control group that was performed in Zahedan MS community, Iran, from September to November 2016. The sample of the study was selected voluntarily from 30 MS patients which were randomly divided into two experimental and control groups. Among 200 patients, 80 patients had the required qualifications to participate in the study and 38 patients volunteered to enter the study. At last, only 30 patients were selected and put randomly into two experimental and control group. The experimental group received treatment in 8 weekly sessions (90 to 120-minute-long sessions with the classroom task and homework and group discussion) but the control group did not go under such treatment. The research instrument being used in this study was Halajian life expectancy questionnaire and mental toughness questionnaire (MTQ-48).
For the groups to be homogeneous in age and the level of education, T-test and chi-squared test were used respectively, which did not show a meaningful difference between experimental and control group. The analysis of covariance showed that cognitive-behavioral therapy (CBT) group has resulted in meaningful increase in mental toughness and life expectancy of patients. The results showed the average of mental toughness to be 1.05 in for the experimental group in the pre-test, 1.24 in the post-test, 1.21 in the follow-up and the average of life expectancy 4.56 before treatment, 7.20 after treatment and 7.01 in the follow-up (P Practicing group cognitive-behavioral therapy in the process of MS patients’ treatment led to the increase in their mental toughness and life expectancy.

The causes of Attention-deficit/hyperactivity disorder (ADHD) (the most common psychological disorder is still unknown. The main symptoms include impulsivity, hyperactivity and attention deficit. Some studies have shown the relationship between ADHD and oxidative stress, and yet some researches have shown the effects on vitamin D on the antioxidants level. This research intends to identify the effect of vitamin D supplementation on the antioxidant serum level in 6-13 years old children with ADHD.
This double blind clinical trial was conducted in Isfahan city, the center of Iran, from October 2015 to February 2016. The sample included 35 subjects of both groups that were randomly selected among 6-13 years old children with ADHD diagnosed by pediatric psychologist. The intervention group consumed 1000 IU of vitamin D3 daily for three months, and the control group used placebo for the same period of time. Their stature and weight were recorded by digital instruments without the shoes with the least clothes. The next step was to train the food record of the students to the parents so that 3 food records were taken during the study. 25-hydroxyvitamin D3 (25(OH)D3), TAC (Total antioxidant capacity), MDA (Malondialdehyde), CAT (Catalase) and GSH (Glutathione) of the participants of both groups were measured before and after the intervention.
In this Study, both groups were adjusted in terms of their age, gender and BMI. The mean score of the variables of leisure time and sport showed no significant difference in the both groups. Comparing the average TAC and MDA between the two groups before intervention didn’t show a significant difference (P1TAC=0.06) (P1MDA=0.32), but after the intervention, the vitamin D intake group showed the increase in TAC and decrease in MDA (P2TAC=0.001) (P2 MDA=0.01). Moreover, CAT and GSH showed no significant difference in the two groups before and after intervention.
Vitamin D supplementation for 3 months led to the improvement of antioxidant capacity by the increase of TAC and decrease of MDA, but the CAT and GSH showed no significant change in the mentioned period of time.

Studies indicate a prevalence of 39.2% diabetes mellitus (DM) as the most common underlying cause in patients with dialysis. Statistics showed that the rates of morbidity and mortality were higher in hemodialysis patients with diabetes compared with hemodialysis patients without diabetes. The aim of this study was to evaluate the risk factors responsible for infections in patient’s chronic renal failure on hemodialysis patients having diabetic foot ulcers.
In this cross-sectional study, data were collected from 30 randomly selected hemodialysis patients who were referred to Imam Reza hospital, Tabriz from April 2016 to April 2017. The patient's records were taken according to inclusion and exclusion criteria and data were collected in designed questionnaires for further analysis.
63.3% of patients were males and 36.7% were females. The average age of study population was 51.23±12.74. Duration of dialysis was 5.15±3.58 years. The average HBA1C was 9.08±1.48. Bacterial cause of feet ulcer was isolated only in 56.7% of cases. Isolated bacteria were anaerobic (47.05%), gram-positive (35.29%) and gram negative (17.64%). Amputation was performed in 26.7% of cases. Mortality was reported in 13.3% of patients. Low personal hygiene, presence of vasculopathy, mortality and amputation was higher in anaerobic infections. Most infections were seen in patients with inadequate dialysis. Low dialysis adequacy, amputation, vasculopathy, increased duration of dialysis, poor hygiene was seen in patients with higher HbA1C.
These results indicate the importance of diabetic foot ulcers caused by anaerobic infections, because of the outcome of amputation and higher mortality rates in these patients, the prognosis is worse than other cases. Also, due to the direct relationship between personal hygiene and the development of anaerobic infections, it is possible to prevent these infections significantly by following these considerations. Most infections were found to be inappropriate in dialysis adequately. Therefore, accurate monitoring of patient's diabetes in the long run and the importance of this can control the complications of diabetes, including vasculopathy, followed by the need for amputation for fighting against diabetic foot ulcers.

Sex determination from human remains is a challenge for forensic experts. Many studies have shown that the finger length ratios might be characteristic for sexual dimorphism. The aim of this study was to determine sexual dimorphism in finger length ratios among Iranian population.
The study group comprised of a random sample of 100 healthy people without congenital or acquired skeletal malformation or other obvious diagnosed disease, with the age range from 19 to 35 years in Tehran and Kashan cities, Iran, from March to the end of August of 2017. The number of male and female samples were equal. The lengths of second (2D), third (3D), forth (4D) and fifth (5D) finger of both hands were measured from the basal crease of the finger proximal to the palm to the tip of the finger using a ruler with a precision of 0.01 millimeters. Exploratory analysis were performed. Different finger ratios including 2D:3D, 2D:4D, 2D:5D, 3D:4D, 3D:5D and 4D:5D were calculated.
The mean ratio of right fingers R 2:3, 2:4, 2:5, 3:4, 3:5, 4:5 and mean ratio of left fingers L 2:3, 2:4, 2:5, 3:4, 3:5, 4:5 were not equal in the groups compared. The index and ring finger ratio is found to be higher in males than females. Ratios of L 2:4, 3:4 and R 2:3, 2:4, 2:5 showed higher values in males.
Our results suggest that the 2D:4D ratio is the most decisive ratio which can demarcate between male and female in Iranian population. It may prove useful to determine the sex of an isolated hand in medicolegal examinations.