Journal of

Background and Aim : Myeloproliferative neoplasms are clonal and heterogeneous disorders of hematopoietic stem cells lead to increase of one or more cell lines in the blood. Recently, the acquired mutation JAK2 V617F has been described in the majority of patients with myeloproliferative neoplasms (MPNs).This mutation is characterized by a G to T transverse at nucleotide 1849 in exon 12 of the JAK2 gene, located on the chromosome 9p, leading to a substitution of valine to phenylalanine at amino acid position 617 in the JAK2 protein. The aim of this study was to assess the prevalence of JAK2 mutation in MPN patients.

Materials and Methods: In this experimental study we evaluated JAK2 mutation in 58 patients with MPNs by simple randomized sampling. The mutation was detected by ARMS-PCR in patients.

Results: The JAK2 V617F mutation was detected in 86.6% (26/30) of patients with polycythemia Vera, 46.6% (7/15) of patients with essential thrombocythemia and 61.5% (8/13) of patients with idiopathic myelofibrosis. Polycythemia Vera patients carrying the mutation displayed a higher levels of WBC (p=0.03) and 61.5% (16/26) of these patients were females. The differences in other groups were not significant. The mutation was confirmed by sequencing.

Conclusions: Our Results show similarity with other studies. Thus, ARMS-PCR can be applied as differential diagnosis test for detection of JAK2 mutation in suspected patients with MPNs.

Background and Aim: One of the main criteria in scientometric evaluation of the medical sciences universities is the number of published articles in the journals that have high Impact Factor (IF). The IF is an indicator to evaluate the journals. Many shortcomings of IF were revealed. This review aims to bring out the challenges of IF and the related solutions of them.

Materials and Methods: Required literatures for this review were collected by searching in related databases such as Web of Science (WOS), Scopus, Google Scholar, and also Google search engine as well as SIGMetrics Discussion Group. Determined search strategy limits search to exact phrase and synonyms. Results selected considering relevancy. The review covers the literatures published between 1972- 2007.

Results: We found at least 18 shortcomings of IF which reduce the efficacy of this indicator. In addition, they stated some solutions versus the shortcomings however, there is no suggested resolution for some of the shortcomings.

Conclusions: Considering the shortcoming of IF, however it could not be ignored because of its accessibility and ease of use. Solely, IF cannot solve the researchers' problem of qualified journal selection. Such solution needs awareness about IF challenges. Readers' judgments and journal clubs are valuable qualitative ways, which can help IF in the evaluation of journals.

Background & Aim: Unified Medical Language System (UMLS) is an extensive ontology of biomedical knowledge developed and maintained by U.S. National Library of Medicine (NLM). Traditional Iranian Medicine (TIM) does not have any position in the structure of metathesaurus of UMLS. The main aim of this study was designing a scheme of TIM cluster's crotch mapping in the structure of metathesaurus of UMLS. Moreover, the TIM position and its proportion in the domain of vocabulary and concepts of universal medical knowledge was another aim of this study.

Materials and Methods: System analysis was the method of this study. To investigate structure of UMLS metathesaurus, and to survey lacking of TIM cluster's crotch, we applied UMLS Knowledge Source (KS) by using inductive, deductive, inductive-deductive approaches. 

Results: One Concept Unique Identifier (CUI) two synonym terms with Lexical Unique Identifier (LUI), L0025131 and L6330122 two ancestor and parent concept nine concepts which with TIM crotch were the child concepts of two ancestor and parent eighteen sibling concepts six narrower and five other related found concepts were identified for the proposal TIM crotch mapping in metathesaurus of UMLS. In addition, we found the "Biomedical Occupation or Discipline" semantic type assigned to it.

Conclusions: Current domain of metathesaurus of UMLS does not represent complete and formal domain and position of TIM. Therefore, this metathesaurus needs to depict a domain and position for TIM.

Background and Aim: Peptic Ulcer Disease (PUD), which is a prevalent disease, can have a considerable impact on patients' quality of life (QOL). The aim of this study was to explore the factors related to QOL based on PRECEDE Model in patients with PUD in Sanandaj, Iran.

Materials and Methods: A non-probability sample of 120 outpatients with PUD, referring to Beasat Hospital, in the city of Sanandaj participated in the study. The study took place between March and June of 2009. A descriptive, cross-sectional design was employed and the data were collected using a survey questionnaire based on PRECEDE model, consisting of QOL, Health Status, predisposing, reinforcing and enabling factors and self-management behaviors constructs. The data collected by interview and analyzed by SPSS v. 11.5. The statistical analysis of the data included Pearson correlation, t- test, one-way ANOVA and linear regression.

Results: Health status (p<0.01), reinforcing (p<0.01) and enabling (p<0.05) factors and knowledge (p<0.05) as a predisposing factor were related to quality of life of peptic ulcer patients. Moreover, health status (p<0.05) and social support as a reinforcing factor (p<0.01) had significant relationships with self-management behaviors. Finally, all of PRECEDE variables accounted for 68.9% of the variation of quality of life in PUD patients.

Discussion and Conclusion: With respect to the results of this study, preparing an educational program to promote self-management behaviors and quality of life in peptic ulcer patients is proposed. It was concluded that the PRECEDE Model may be used in developing countries, like Iran, as a framework for planning intervention programs in an attempt to improve the quality of life of patients with PUD.

Background and Aim: Today, cardiovascular diseases are the most important public health challenges in the world. Prevention and management of cardiovascular diseases necessitate the existence of a comprehensive system for recording data. Patient medical document is one of the most important data which should be classified so to facilitate and expedite the treatment process. A comparison of cardiovascular disease classification systems could assist health care policy makers to battle cardiovascular diseases.

Materials and Methods: This descriptive-comparative study conducted during years 2007-2008. The cardiovascular diseases classification systems in USA, Australia, England and Canada were reviewed. Data collecting was done through literature review, Internet and e-mail.

Results : The cardiovascular disease classification systems of all the developed countries are national. The developed countries, with the exception of England, utilize a multiracial classification model, especially designed to reflect the individual requirements of every single one of them. This model employs health care standards, e-learning, annual educational programs, and consultation with experts. Iran lacks such a national classification system for cardiovascular diseases.

Discussion and Conclusion : In order to improve the management and prevention of cardiovascular diseases in Iran, it is essential that the cardiovascular disease classification system in the country be national.

Background and Aim: The JAK2 is an acquired mutation that is observed in majority of patients with classical Philadelphia-negative Myeloproliferative neoplasms that include polycythemia vera (PV), essential thrombocythemia (ET), primary myelofibrosis (PMF). This acquired mutation is characterized by a G to T transversion at nucleotide 1849 in exon 12 of the JAK2 gene, leading to a substitution of valine to phenylalanine at amino acid position 617(V617F) of the JAK2 protein, and result in constitutive JAK2 activation that promotes hypersensitivity to growth factors and cytokines.

Materials and Methods: In this study we evaluated RNA from 58 patients with MPNs and statistical analysis was done with mann whitney test. The mutation detected by AS-PCR. In addition, 3 samples were sequenced in Mille gen company.

Results: 46 patients:86.6%(26/30) of those with polycythemia vera, 53.3% (8/15) of those with essential thrombocythemia,61.5% (8/13) of those with idiopathic myelofibrosis polycythemia vera patient carrying the mutation displayed higher levels of WBC (p=0.03). on the other hand,16 out of 26 JAK2V617F positive patients were female there is a demonstrate correlation between the presence of a mutant allele and female gender. The difference in other groups were not significant.

Discussion and Conclusion: The JAK2V617F mutation has been detected in the vast majority of patients with polycythmia vera (65-95%) and in a lower frequency in patients with essential thrombocythemia (23-57%), idiopathic myelofibrosis (23-57%) and chronic myeloid leukemia 19% (3/16 CML Ph-). Detection of the mutation is helpful in differential diagnosis, prognosis, and prediction of therapeutic response.

Background and Aim: The production of science is the key element of program to achieve sustainable development. Currently, the most important characteristic to produce knowledge is the number of document indexed from scientific journals in databases that do bibliometry and Scientometrics study. The aim of this study is evaluation of scientific production of Iranian medical domain based on the document indexed form scientific journal in chosen database, between 2005-2009.

Materials and Methods: Analytical- descriptive method and bibliometry analytic was adapted. The study population includes all scientific journals that was published in English and indexed in WOS and Scopus until of the time of this study. Data collection tool was check list that was made by researchers & complete by referring and direct observation in WOS and Scopus databases. Data was analyzed by SPSS and other statistical methods.

Results: Showed that from 44 journals title that studied, 18 titles was indexed in WOS and 20 titles was indexed in Scopus. The number of records and citation, according to the review with passing year, has been rising. Maximum number of documents and citations are related to the final years. Number of records in the Scopus database is more than WOS, but the differences in not significant (P- value = 0/186).

Discussion and Concoction: Journals visibility in the medical science filed in review databases in not desirable. Less than 50 percent of scientific journals were indexed in databases. Between the years studied, the scientific production of medical area of the country has been growing but to reach the proper situation, more effort is required.

Background and Aim: Females were reported to have significantly lower hematocrit (Hct), which might be the cause of increased need for blood transfusion. The goal of this study is to determine risk factors affecting blood transfusion in patients undergoing coronary artery bypass graft procedure related to gender

Materials and Methods: A cross sectional review of 500 (306 males and 194 females) ASA physical status I or Il patients undergoing bypass procedures with saphenous vein graft performed over a one year period were included in this study. The conducting of anesthesia was standardized. For each patient, we recorded the gender, age, body weight, height, body surface area (BSA), and duration of surgery. Hematocrit levels prior to surgery and the end of surgery were recorded. Packed red blood cell (PRBC) administration and use of fresh frozen plasma (FFP) and platelets were noted. Differences between the data for female and male patients were evaluated using Student's t-test, Chi-square test and using regression analysis.

Results: Approximately 57.2 % (111) female and only 39.9% (121) male patients received PRBCs. On average, females received 1. 6 units of PRBCs intraoperatively and 2. 6 units of PRBCs during the entire hospital stay, while the males received 1.1 units and 1.8 units for similar periods (P=0.0001). When females and males were compared within the same subgroups for age, body surface area (BSA), duration of surgery, and preoperative Hct, etc. ...had a significant correlation with age, postoperative Hct and BSA in females but had a significant correlation with preoperative Hct, preoperative PRBC and duration of surgery in males (P<0.05). Multiple logistic regression analysis showed that the probability of a patient receiving or not receiving PRBC transfusion is significantly influenced by preoperative Hct, postoperative Hct, duration of surgery, preoperative PRBC mass, and gender.

Discussion and Conclusion: Gender is an independent essential determinant of blood transfusion in CABG patients, and may interact with BSA, preoperative Hct, duration of surgery and other factors in determining the probability of transfusion.

Background and Aim: Bone sialoprotein (BSP) is a specific marker of osteoblastic differentiation. In this research, the effect of Zoledronic Acid on BSP expression and methylation status during osteoblastic differentiation of mesenchymal stem cells (MSCs) was evaluated.

Materials and Methods: In this experimental study, MSCs were isolated from human bone marrow. For osteogenic differentiation, hMSCs were pulse treated with zoledronic acid, and were incubated in osteogenic differentiation medium for 3 weeks. The DNA and RNA were extracted after the first, second and third weeks of culture and also from undifferentiated MSCs. After Sodium bisulfate (SBS) treatment, gene specific methylation analysis for BSP was carried out using Methylation Specific PCR technique.

Results: BSP expression was observed in osteoblastic differentiated cells whereas it was not seen in MSCs. MSP showed that BSP was unmethylated during osteoblastic differentiation.

Conclusion: BSP was expressed from the first week of differentiation. This confirms that zoledronic acid accelerates osteoblastic differentiation. Unmethylation status of BSP indicates that zoledronic acid does not have any effect on BSP methylation status. Other genetic or epigenetic mechanisms may control BSP expression during osteoblastic differentiation induction by zoledronic acid.

Background and Aim: Self-citation, as one of the limitations of citation analysis, unusually affects the ranking of journals. This study aims to evaluate the degree of relationship between self-citation and immediacy index correlation of Iranian medical journals indexed in Scopus Citation Index between 2005 and 2009.

Materials and Methods: The method of the study is survey-descriptive in which citation analysis is used. The study included all Iran-based English medical journals indexed in Scopus database up to May 2009. The control list was prepared and its validity was confirmed. Data were collected by referring to Scopus website and publication review resources, and analyzed by statistical software and appropriate methods.

Results: The findings showed that self-citation rate of journals was 29.64 percent, which comprised 14.43 percent of the total number of citations. There was a significant relationship (at the level of 0.01) between self-citation rate and immediacy index of journals (p = 0.591). Besides, Pearson correlation coefficient showed a significant relationship between the number of journals' articles and the journals' immediacy indexes excluding self-citation during the years of study.

Conclusion: Self-citation has a direct effect on journals' immediacy index that is, an increase in the rate of self-citation causes an artificial increase in the journals' immediacy index. On the other hand, immediacy index is affected by the number of journal articles. Therefore, the reduction or elimination of self-citation seems to be necessary for the journals and can put them in their right place.

Background and Aim: Identification of entrepreneurial opportunities in the field of nutrition counseling is a central issue in employing nutrition consultants and meeting the needs of patients with chronic diseases better. To this end, the present survey has been conducted in order to analyze the supply and demand trends of diabetes nutrition counseling as a basic step toward identifying the entrepreneurial opportunities for nutrition consultants in Tehran.

Materials and Methods: To implement this descriptive-survey study, a questionnaire based on Likert scale was sent by email to 80 active professionals in the field of nutrition counseling services in Tehran, of whom 48 responded to its questions. Then, using SPSS11.5, the mean values of participants' responses were calculated and compared with one another.

Results: The findings obtained based on participants' responses revealed that the need for "nutritional counseling in the form of a treatment team" was mostly not met in different age, education and income groups of diabetic patients

Conclusion: "Nutrition counseling in the form of a treatment team" can be considered as a suitable field for entrepreneurial activities.

Background and Aim: Increase in life expectancy is associated with non-communicable diseases. This study is aimed to survey the effect of chronic diseases on the quality of life among the elderly people in elderly care centers in the East of Tehran in 2011.

Materials and Methods: This is an analytical study in which 424 people were randomly selected. They were members of elderly care centers and were 60 years of age or higher. The data collection instruments were a standard quality-of-life questionnaire(SF36) and a chronic diseases record checklist. The data were collected in an interview. For data analysis purposes, Independent T-Test, ANOVA, and Pearson correlation coefficient were used.

Results: The mean age of participants was 67.34±7.16. Some 92.2% of patients were suffering from at least one chronic disease, and there was a significant statistical difference between the mean points of all aspects of quality of life of those suffering from chronic diseases and those without a history of chronic diseases(P<0.001). Moreover, there was a significant relationship between the quality of life on the one hand and gender, marital status, economic status, and education on the other(P<0.05).

Conclusion: The findings show that an increase in the number of chronic diseases leads to a decrease in the quality of life, and that the application of appropriate educational and interventional approaches can help take effective steps to enhance the old people's health.

Background and Aim: Based on theories and researches, two variables effective in the continuous improvement of services are trust in and identification with hospital goals. The present study aims to explore the relationship between such variables among nursing staff members in private hospitals of Shiraz.

Materials and Methods: This research is a cross-sectional correlation study. Some 340 nurses(58 males and 282 females) were selected using the stratified sampling technique.
Three questionnaires for the assessment of identification with hospital goals, measurement of continuous improvement, and determination of trust in hospital were used. The reliability of data collection devices turned out to be 0.70, 0.70 and 0.79, respectively. Besides, the construct validity was confirmed through factor analysis. Data were analyzed inferentially using Pearson's correlation test and hierarchical regression analysis.

Results: The findings show that the relationship between identification with hospital goals and trust and nurses' effort to improve continuously is positive and significant. Moreover, the results of hierarchical regression analysis show that after controlling gender, age, experience and education, first identification with hospital goals and then trust in hospital play a significant role in the effort to improve continuously.

Conclusion: Nurses' effort to improve continuously is mostly influenced by identification with hospital goals rather than trust in hospital.

  Background and Aim: Family physician is the core in the world efforts for quality improvement, cost effectiveness, and equity in the health care systems. The main purpose of this present study was to investigate situation of the family physician program and identify referral route in this program in six pilot cities in Khuzestan province .

  Materials and Methods: A cross-sectional descriptive study was conducted in 2011. Pre-designed checklists were used for collecting data. In this study, 15 healthcare team in six pilot cities for family physician program in Khuzestan province were examined and their specified referral levels for each city was investigated and compared with the national instruction to identify current gaps.

  Results: The least number of staff belonged to nutrition, nurses and physicions respectively. In the second referral level cities, Specialists did not welcome the program . In Mahshar, a second level city, five specialists have been registered to family physician program. In the third level, 28/5 percent of specialist were enrolled in this program.

  Conclusion : It seems that it is necessary to facilitate patient access to physicians under contract with family physician program and referral system in second and third levels. Therefore, establishing a motivation system for attracting specialist and improving their maintenance situation can also be beneficial.

Background and Aim: FRBR is one of the models considered in cataloging and work-to-work relationships are introduced as types of bibliographic relationships present in this model.

This study examines the distribution of dispersion relationships in medical subject areas based on FRBR model in Persian medical sources published from 2006 to 2010.

Materials and Methods: This study is a descriptive survey . Data were obtained from Iranian OPAC ( online public access catalog) . To determine the areas of medical sciences, both LC (Library of Congress) and Dewey Classifications were applied. For data analysis, Excel 2007 was used. Using descriptive statistics, the researcher presented the results in the form of tables and graphs.

Results: According to Dewey Classification, ‘diseases’ was the subject area having the highest number of bibliographic relationships and the lowest frequency belonged to ‘experimental medicine’. The analysis based on LC Classification, however, showed that ‘internal medicine’ had the highest number of bibliographic relationships Botanic, Thomsonian, Eclectic Medicine, Chiropractic and Alternative medicine subject matters had the lowest bibliographic relationships.

Conclusion : Distribution of work-to-work bibliographic relationships in Persian medical sources based on Dewey and LC Classifications is heterogeneous. Despite the obtained apparently heterogeneous results, such a difference cannot be due to differences in the frequency of bibliographic relationships of medical topics because the classification criteria of medical sciences are different in these two systems.

Background and Aim: Open access to scientific information is a new paradigm in scientific communication that facilitates access to research. This study was carried out to identify Tehran University of medical science faculties members’ familiarities with Open access and to survey their attitude about it.

Materials and Methods: A descriptive survey method was applied. The study population consisted of 163 members of Tehran University of Medical Sciences. Data gathering tool was questionnaires that its validity and reliability was confirmed. Data was collected and analyzed by SPSS software and descriptive statistic methods.

Results: Results show that more than 50 percent of population have modest familiarites with Open acces. Furthermore, the faculties’s members familiarites with Open access technique was moderate. More than 70 percent (114 person) of them have positive attitude toward Open access and it’s techniques.

Conclusion : Faculties members’ familiarity with Open access relatively is low but when they received information about the concept, rules and aim of this paradigm, their attitudes positively changed. Therefore, open access should be considered as a perfect method in scientific communication.

 Background and Aim: Evidence Based Medicine (EBM) is the explicit use of current best evidence in making decisions about the care of individual patients. Hospital information system (HIS) can act as a bridge between medical data and medical knowledge through merging of patient's data, individual clinical knowledge and external evidences .The aim of this research was to determine the Capability to establish EBM by HIS.

 Materials and Methods: This descriptive cross-sectional study was carried out on HISs of 30 hospitals from March to October 2011. Data were collected using a researcher- constructed checklist including applicant’s background information as well as information based on research objectives. Validity of the checklist were assessed by the qualified specialists and then the data were analyzed using descriptive statistics and SPSS software.

 Results: HISs lacked the essential components for providing access to CDSS, Reference databases and internet-based health information in 19, 16 and 20 hospitals were 63.3%, 53.3% and 66.7%, respectively. Twenty-two hospitals (70%) had more than two-thirds of the essential components to access clinical and administrative data repositories 23 hospitals (76.7%) had at least one essential component to access contextual and case specific information.

 Conclusion: The Capability of HIS is better in order to place EBM in having access to the clinical and administrator data repositories while it needs more attention in other areas.

 Background and Aim: Scientific journals are the most major tools in disseminating research findings. With the increasing number and price of scientific journals, libraries need to select journals. Citation analysis is a practical method in identifying the best titles to be subscribed. This study was to identify core journals in the field of dentistry using citation analysis.

 Materials and Methods: Two hundered and seventy six documents including dentistry theses (241 titles) and faculty papers (35 titles) indexed in Science Citation Index (SCIE) were selected and their references were extracted and evaluated using citation analysis methods. The distribution frequency of journals confirmed the Bradford’s Law of Scattering representing core dentistry journals.

 Results: Eleven thousand twenty three references were totally extracted. Average reference per theses and papers was 39/25 and 44/74, respectively. English journals and books were the most frequent referred documents having 95% of total references approximately. The most updated references were in English dated during 2001-2005 and 2006-2010. Using the Bradford’s Law, five journals were introduced as core dentistry journals.

 Conclusion: Selecting and subscribing core journals leads into cost-effectiveness in libraries and plays an important role in meeting user’s needs. While having many challenges in accessing scientific resources, core journals selection and subscription is an intelligent action resulting in effective use of financial resources. 

 Background and Aim: Cream is a rich dairy product with the pH close to neutral and limited preservation capability. Cream is suitable and rich for microbial growth. In the past few decades, there was a great concern in contamination of food products.

 Salmonella and Yersinia species are two important pathogens causing food poisoning and human gastroenteritis. The aim of the present study is to investigate the quality of traditional cream for bacterial contamination.

 Materials and Methods: This is a cross-sectional study. In total, 100 unpasteurized cream samples were collected from 5 regions in Tehran. The Salmonella was enriched in Selenite-F broth, and Yersinia in phosphate buffer in two weeks in cold condition according to CDC, and then were inoculated in MacConky and CIN agar for 24 hours. The suspected colonies were examined for phenotype and their identification was confirmed by API-20 E.

 Results:  In general, 29% of tested cream samples were contaminated with at least one kind of bacteria, 3% with Yersinia (1strain Y.enterocolitica, 1 Y.intermedia, 1 frederiksenii), and 2% with Salmonella paratyphi B. The other bacteria like Escheichia coli, Enteobacter, klebsiella, and Citobacter were also isolated. Five samples were contaminated with two kinds of bacteria.

 Conclusion: The results of this study indicate that more quality control should be applied on the cream produced in the city of Tehran by health control office for food products. 

 Background and Aim: The risk of breast cancer increases directly in line with breast density. Therefore, it is important to pay more attention to denser breasts in order to detect abnormalities. The aim of this paper was to design and suggest a quantitative method to categorize breast density in digital mammogram images using fuzzy logic.

 Materials and Methods: This was a crosectional study which resulted in developing a new system. The research population was including patients who undergo mammography in National Cancer Society of Malaysia during 2010 to 2011. Sample included 220 mammogram images which was selected randomly. Data analysis was done using SPSS with Kappa statistics.

 Results: Accuracy level of 92.8% was obtained based on evaluation of the system and there was a strong correlation between the system output and radiologists’ estimation (K=0.87, p=0.0001).

 Conclusion : Results obtained from the suggested system had higher performance than similar systems. Therefore, it could be concluded that the fuzzy logic may be used in this area. In addition, such systems could be helpful for physicians.