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Conventional Vs. reverse nerve grafting for peripheral nerve repair in lower extremity of rats
Akbari H, Fatemi Mj, Shakour Z, Mousavi Sj, Madani P, Pedram Ms,
Volume 70, Issue 10 (4 2013)
Abstract

Background: Autograft is the best option in nerve defects when end-to-end repair can not sufficiently preserve nerve continuity. Theoretically, if the severed nerve is reversely grafted, it may prevent axonal growth into nerve branches, and larger amounts of axons will reach the target organ and more satisfactory results will be obtained. In this study we aimed to compare conventional versus reverse nerve grafting.
Methods: This study was performed in Animal laboratory of Hazrat Fatemeh Hospital from April till August 2011. We randomly divided 40 Wistar rats into two groups. We excised 1.5 cm of the right sciatic nerve and anastomosed it conventionally between the proximal and distal ends of the nerve in rats in group A and in a reverse manner in rats in group B. The rats’ footprints were recorded in the first and 16th weeks after surgery. In week 16, the grafted nerves were removed under anesthesia for pathological examination and axon count. Subsequently, the results were compared clinically by sciatic functional index (SFI) through footprint analysis and paraclinically by axon count. A p-value smaller than 0.05 was considered statistically significant.
Results: Conventional and reverse nerve grafting no had statistically significant differences in clinical assessment in the first and 16th weeks (P=0.87) post-surgically and also no difference in paraclinical assessment in week 16 (P=0.68).
Conclusion: We had no significant clinically or para clinically differences between two approaches. It should be considered that the diameter and length of nerves and muscles in human is larger than rats, so the results of nerve repair may differ in human. We suggest a study in animal model which is anatomically more similar to human.


Long QT in children with congenital deafness: a brief report
Naseraldin Akbari Asbagh , Parvin Akbari Asbagh , Zarrintaj Keihanidoust , Aliashraf Eghbali ,
Volume 71, Issue 5 (August 2013)
Abstract
Background: Long QT syndromes (LQT) are genetic abnormalities of ventricular repo-larization, with an estimated incidence of about one per 10000 births. It is characterized by prolongation of the QT interval in electrocardiogram (EKG) and associated with a high risk for syncope and sudden death in patients. Type of this syndrome is association with congenital deafness. Our objective was to evaluate QT interval in children with congenital deafness.
Methods: For 219 patients referred to Imam Khomeini Hospital audiometric clinic in 2011, questionnaire were completed. A total of 23 congenitally deaf children were incl-uded. All patients’ examinations were done by a pediatric cardiologist. Electrocardio-gram is conducted in all children (23 patients) with sever and deep congenital deafness. Then the QT interval was measured based on Bazett’s formula. Echocardiography was also performed in these children to assess left ventricular function and the presence of mitral valve prolapse.
Results: The overall patients were two hundred and nineteen children. A total of twenty three congenitally deaf children were included and electrocardiogram was obtained. Three children had obviously prolonged QTc (0.48±0.02) second. The median age of them was 6.1±5 year, the median weight was 18±11.3 kilogram and the median of QT interval was 0.48±0.02 second.
Conclusion: The QT interval obtained 0.48±0.02 second. In the present study we found prolonged QT in congenital deafness, thus we recommend to evaluate the electrocardio-gram of children with congenital deafness.

Prevalence of congenital Toxoplasmosis in two university hospitals: a brief report
Samileh Noorbakhsh , Majid Kalani , Ali Mohamad Aliakbari , Azardokht Tabatabaei , Fahimeh Ehsanipour , Reza Taghipour , Mohamad Reza Shokrolahi ,
Volume 71, Issue 6 (September 2013)
Abstract
Background: The incidence and clinical presentation of congenital toxoplasmosis in our newborns was not studied until yet. Goal of study is to evaluates the newborns for congenital Toxoplasma.Gondii infection and describe the clinical presentation from birth and follow up them. 
Methods: We conducted a prospective study upon 270 newborns were born in two university hospitals in Tehran (Rasoul akram & Akbar Abadi) during 2011-2012. Cord blood sample obtained from the newborns during labour. The samples centrifuged, transported and restored in -80 centigrade freezer in our Research Laboratory. Specific T.Gondii- antibodies (IGG, IGM) evaluated by ELISA methods. Neonates with positive T.Gondii- IGM diagnosed and studied as infected cases. The infected cases treated and followed for progression of disease.
Results: Gestational age of newborns was between 28-41 weeks. Positive T.Gondii -IGM and T.Gondii -IGG determined in 1.5%, 44.1% of cases respectively. The most common clinical presentation in seropositive cases was eye involvement (50%), and brain disorders (50%). Positive PCR had not found in cerebrospinal fluids of seropositive (IgM) cases.
Conclusion: One and a half percent of newborns were seropositive for T.Gondii. Wide variation of clinical presentation and early diagnosis of infected newborns in our country is so important. Adding the serologic tests (IGM) to neonatal screening test is recommended strongly.

Effects of exercise and supraphysiological dose of nandrolone decano-ate on the rat plasma opioid level: a brief report
Mehdi Mohebi , Khalil Pourkhalili , Mahnaz Kesmati , Samad Akbarzadeh , Zahra Akbari ,
Volume 72, Issue 3 (June 2014)
Abstract
Background: Anabolic-Androgenic Steroids (AAS) are mainly abused by athletes for improvement of muscle performance. Data suggest that the effect of AAS on neurobiochemicals related to behavioral response, may be underlies psychological adverse effects. Physical activity has beneficial psychophysiological effects, which may be related to increased serum levels of endogenous opioid peptides during exercise. In the present study we aimed to study the effect of chronic administration of nandrolone decanoate on beta-endorphin and met-enkephalin level in exercising rats. Methods: In this experimental study, forty male Wistar rats were randomly assigned in two main groups of sedentary and trained (2 weeks swimming exercise). Animals in each group were divided in two subgroups of control (received nandrolone solvent) and drug treatment (received nandrolone 15 mg/kg, 5 times/week). After two weeks of swimming exercise and drug treatment, serum levels of beta-endorphin and met-enkephalin were measured using ELIZA. Results: Our data showed that two weeks of swimming exercise training significantly increased serum beta-endorphin (114±5 vs. 98±5 ng/l in control group, P= 0.038) and met-enkephalin levels (1556±42 vs. 1475±27 ng/l in control group, P= 0.25). However, chronic administration of nandrolone decanoate in trained group considerably de-creased beta-endorphin (84±4 vs. 114±5 ng/l in control group, P= 0.002) and met-enkephalin levels (1378±36 vs. 1556±42 ng/l in control group, P= 0.011). The effect of supraphysiologic doses of nandrolone decanoate in control sedentary group was not statistically significant. Conclusion: In the present study we show that chronic nandrolone decanoate admin-istration attenuates effects of two weeks swimming exercise on serum opioid peptide and reduces the level of beta-endorphin and met-enkephalin. Keeping in mind that opi-oidergic system play an important role in behavior, athletes abusing anabolic steroid drugs may potentially experience changes in mood and behavior.
Prophylactic teatment with oral paracetamol for patent ductus arteriosus in preterm infants: a randomized clinical trial
Parvin Akbari Asbagh , Mohammad Reza Zarkesh , Firoozeh Nili , Fatemeh Sadat Nayeri , Azam Tofighi Naeem ,
Volume 73, Issue 2 (May 2015)
Abstract
Background: The incidence of Patent Ductus Arteriosus (PDA) in premature infants whose birth weight is less than 1500 grams is approximately 30-60%, most of them need medical or surgical interventions. The purpose of this study is to determine the efficacy of prophylactic treatment with oral paracetamol (Acetaminophen- Hakim® Oral Drops 100 mg/ml, Hakim Pharmaceutical Co., Tehran, Iran) for PDA in preterm infants. Methods: A randomized clinical trial conducted from March 2012 to March 2013. Thirty-two preterm newborns whose gestational age was under 32 weeks and birth weight was 1500 grams or less, admitted in neonatal intensive care unit (NICU) of Vali-Asr Hospital, Tehran were studied prospectively. They were randomly assigned in two groups. The prophylaxis group received oral paracetamol for a period of two days starting during first 24 hours of life. No placebo was given to the control group. Echocardiography was performed 24-36 hours after the last given dose in prophylaxis group and on the 4th and 5th day in control group. A p-value less than 0.05 are considered significant. Results: There were 16 newborns in each group (20 boys and 12 girls). In 12 newborns of prophylaxis group the ductus arteriosus was closed although in control group in 8 newborns the duct was closed. No significant difference was observed in sex, gestational age, birth weight, mode of delivery, multifetal gestation and birth order between two groups. The rate of ductal closure was 75% and 50% in prophylaxis group and control group respectively (P=0.27). Conclusion: Our study demonstrated that prophylactic paracetamol is ineffective in PDA closure, although the rate of ductal closure between two groups seems remarkable. Paracetamol as a new strategy for PDA closure because of cost effectiveness and harmlessness may be used in future. However, we presume larger sample size studies are needed to show the efficacy of paracetamol, side effects, and complications in PDA prophylaxis treatment.
Designing an artificial neural network for prediction of pregnancy outcomes in women with systemic lupus erythematosus in Iran
Mahmoud Akbarian , Khadijeh Paydar, Sharareh R Ostam Niakan Kalhori , Abbas Sheikhtaheri ,
Volume 73, Issue 4 (July 2015)
Abstract
Background: Pregnancy in women with systemic lupus erythematosus (SLE) is still introduced as a major challenge. Consulting before pregnancy in these patients is essential in order to estimating the risk of undesirable maternal and fetal outcomes by using appropriate information. The purpose of this study was to develop an artificial neural network for prediction of pregnancy outcomes including spontaneous abortion and live birth in SLE. Methods: In a retrospective study, forty-five variables were identified as effective factors for prediction of pregnancy outcomes in systemic lupus erythematosus. Data of 104 pregnancies in women with systemic lupus erythematosus in Shariati Hospital and 45 pregnancies in a private specialized center in Tehran from 1982 to 2014 in August and September, 2014 were collected and analyzed. For feature selection, information of the 149 pregnancies was analyzed with a binary logistic regression model in SPSS software, version 20 (SPSS, Inc., Chicago, IL, USA). These selected variables were used for inputs of neural networks in MATLAB software, version R2013b (MathWorks Inc., Natick, MA, USA). A Multi-Layer Perceptron (MLP) network with scaled conjugate gradient (trainscg) back propagation learning algorithm has been designed and evaluated for this purpose. We used confusion matrix for evaluation. The accuracy, sensitivity and specificity were calculated from the confusion matrix. Results: Twelve features with P<0.05 and four features with P<0.1 were identified by using binary logistic regression as effective features. These sixteen features were used as input variables in artificial neural networks. The accuracy, sensitivity and specificity of the test data for the MLP network were 90.9%, 80.0%, and 94.1% respectively and for the total data were 97.3%, 93.5%, and 99.0% respectively. Conclusion: According to the results, we concluded that feed-forward Multi-Layer Perceptron (MLP) neural network with scaled conjugate gradient (trainscg) back propagation learning algorithm can help physicians to predict the pregnancy outcomes (spontaneous abortion and live birth) among pregnant women with lupus by using identified effective variables.
The prevalence of left ventricular heart failure in chronic obstructive pulmonary disease patients: brief report
Shirin Izadi , Hounaz Akbari , Behzad Farahani , Shahrokh Izadi ,
Volume 73, Issue 4 (July 2015)
Abstract
Background: Chronic obstructive pulmonary disease (COPD) and heart failure are prevalent comorbidities affecting a vast proportion of the world population, responsible for significant morbidity and mortality, their coexistence is more frequent than previously recognized that poses important diagnostic and therapeutic challenges. We intend to determine the prevalence of concomitant left ventricular dysfunction in COPD patients. Methods: We performed a cross-sectional study in patients who had referred to Firuzgar University Hospital in Tehran from March 2011 to March 2013 in period of 2 years. All participants were compatible for including and excluding criteria’s. In all cases of COPD, pulmonary function test was done also Echocardiography was performed as the diagnostic assessment of heart failure. Results: Out of 74 participants there was 56(75.7%) male and 18(24.3%) female with the mean age of 67.712.9 (SD), the prevalence of left ventricular systolic dysfunction (LVSD) was 25.70%, also the prevalence of left ventricular diastolic dysfunction (LVDD) was 74.60% among 71 patients. The prevalence of LVSD in patients with and without history of coronary artery disease (CAD) was 33.30% and 15.60% respectively. The prevalence of LVDD was 85.40% in patient with history of CAD and 60% in patients without it. The presence of ventricular dysfunction (neither systolic nor diastolic) in COPD patients was not statistically associated with presence of CAD or the intensity of underlying COPD disease. Conclusion: Knowledge about the prevalence of concomitant left side heart failure in COPD patients is limited, but it seems the presence is rather common, so more attention should be paid to coexistence of ventricular dysfunction in COPD patients disregarding presence of CAD or COPD intensity in clinical practice.
Safety and effectiveness of everolimus compared with sirolimus and tacrolimus in preventing kidney transplantation rejection: a systematic review and meta-analysis
Morteza Arab Zozani , Seyyed Alireza Hosseini , Ali Akbari Sari , Mitra Mahdavi-Mazdeh, Seyyed Reza Majdzadeh , Ashraf Velayati ,
Volume 73, Issue 5 (August 2015)
Abstract
Background: Everolimus is an immunosuppressive agent with a novel mode of action but has a different clinical role with calcineurin inhibitors (CNI). The aim of this study was to evaluate the safety and effectiveness of everolimus compared with sirolimus and tacrolimus in preventing kidney transplantation rejection. Methods: Search was conducted for finding randomized clinical trials (RCT) until the end of 2013 in main databases include Cochrane, Medline and other related databases in February 2014. To find the ongoing trials two databases were searched (Clinicaltrial.gov and irct.ir/fa/). Two independent reviewers checked studies for quality and eligibility and finally extracted the data. Data extraction was performed using Cochrane data extraction form for clinical trial. Discrepancies were resolved via consultation with third person. The studies examined in term of heterogeneity with I2 and Chi-square test. The mata-analysis was carried out using RevMan 5.2 (Wintertree Software Inc, Ontario, Canada) when there was homogeneity. Results: Finally, seven reports from six RCTs included in this study. All reports were in english language and total numbers of participant in these studies were 824. No studies were found in comparison of everolimus and sirolimus and all seven reports were combination of everolimus, tacrolimus and other relative drugs. Follow up time of studies were different from 6 to 36 months. Due to the heterogeneity of included studies, only two studies were entered into meta-analysis. The recorded mean values for glomerular filtration rate, serum creatinine and creatinine clearance were between 60-80 ml/min, 50 to 80 ml/min and 1.2 to 1.9 mg/dl respectively. The results of meta-analysis in three outcomes include serum creatinine, creatinine clearance and glomerular filtration rate were significantly in favor of low dose tacrolimus plus everolimus. Conclusion: In general, everolimus showed better results in combination with tacrolimus. Given the available evidence in this study, everolimus in combination with low dose tacrolimus showed better safety and effectiveness in preventing kidney transplantation rejection.
Age-specific reference ranges of serum prostate-specific antigen in Iranian men
Gholamreza Pourmand , Mohsen Ayati , Ali Razi , Aliakbar Karami , Rashid Ramazani , Ayat Ahmadi , Parvin Akbari Asbagh, Rahil Mashhadi , Shadi Pourmand ,
Volume 73, Issue 5 (August 2015)
Abstract
Background: Prostate-Specific Antigen (PSA), also known as gamma-seminoprotein or kallikrein-3 (KLK3), is the best marker for early diagnosis of prostate cancer. Since age and race are affecting PSA levels, determining age-specific reference ranges of PSA in every community is necessary for increasing the efficiency rate of PSA. The aim of the present study was to evaluate the normal distribution of total prostate-specific antigen (TPSA) and free prostate-specific antigen (FPSA) and determine age-specific reference ranges of PSA in Iranian men. Methods: In this cross-sectional study, 1200 normal men with the age range of 50 to 79 referred to Shahid Rajaie Hospital, Qazvin Province in Iran, from 2011 to 2013. After excluding patients with prostate cancer and urinary tract infection, 1020 men were included in this study. Then, their blood samples were collected and after the extraction of serum from blood, serum levels of FPSA and TPSA were measured using commercial kits the reference range of PSA was specified for each age group and compared with reference ranges of other populations. Results: The mean age of the patients was 61.03±7.5 years and the mean values of FPSA and TPSA were 0.47±0.6 ng/ml and 1.56±2.05 ng/ml, respectively. PSA serum levels (95th percentile range) in 50 to 59, 60 to 69 and 70 to 79-year age groups were 0-3.6 ng/ml, 0-5.7 ng/ml and 0-6.8 ng/ml, respectively. TPSA (r= 0.2, P< 0.001) and FPSA (r= 0.22, P< 0.001) were significantly associated with age. In addition, a significant relationship was found between TPSA serum levels and alcohol consumption (P= 0.017), smoking (P< 0.001) and family history of prostate cancer (P= 0.014). Conclusion: Findings of the present study showed that PSA levels are correlated with age. It was also revealed that the PSA age-specific reference range obtained in this study is different from other races and is specific to Iranian men. Therefore, age-specific reference ranges of PSA obtained in the present study can increase PSA test sensitivity and specificity by reducing unnecessary diagnostic procedures and early detection of prostate cancer in Iranian men.
The effect of Coriander cream on healing of superficial second degree burn wound
Abolfazl Abbas Zadeh, Tayebeh Mahzooni , Seyed Abolhasan Emami , Hossein Akbari , Mohammad Javad Fatemi , Mohsen Saberi , Tooran Bagheri , Mitra Niazi , Shirin Araghi ,
Volume 73, Issue 9 (December 2015)
Abstract

Background: Coriander with the binominal name of Corianda Sativum, is one of the oldest medicinal plants ever known to man. Anti-inflammatory, anti-microbial, and anti-fungal effects of its oil has been mentioned in numerous studies. This study examines the impact of coriander cream on wound healing of the second-degree singe burn.

Methods: In this experimental study which was performed in the animal lab of the Hazrat Fatemeh Hospital in Tehran, 48 adult male rats with an approximate weight of 250-300 grams, with deep burns of 2 cm 4×2 dimensions were prepared and divided into 4 groups of 12. We used silver sulfadiazine cream, alpha ointment, coriander cream and vaseline gauze (control group) dressings in burn wound of the groups 1 to 4 respectively. At the end of the study (30 days), rats were euthanized with a high dose of thiopental and the wounds were evaluated on days 10 and 17 with a punch biopsy. Samples were fixed with 10% formalin on histopathology slide using haematoxylin and eosin (H&E) staining (to assess and determine the presence of inflammatory cells). The amount of fibrin and collagen at the site were evaluated using a software program ImageJ, version 1.45 (National Institutes of Health, Bethesda, Maryland, USA).

Results: The mean of wound surface area in the first photography was no significant (P= 0. 135). The rate of wound healing in alpha ointment and coriander cream had better outcomes than either of the other two groups (P= 0.000). The healing of the wound in silver sulfadiazine group was significantly less than other groups. Pathology results showed a statistically significant difference between the four groups (coriander, alpha, SSD and control), based on the Kruskal-Wallis test. These relate to (1) polymorphonuclear in the first (P= 0.032) and the second series (P= 0.003), (2) Angiogenesis in the second series (P= 0.004). (3) Fibrosis in the first series (P= 0.024) and the second series (P= 0.000).

Conclusion: The results of this study showed that wound healing improvement in coriander cream group was better than the control group and silver sulfadiazine group and similar to alpha ointment group.


The effect of recombinant follicle-stimulating hormone on semen parameters after varicocelectomy in infertile men
Atoosa Bagheri Behzad, Barzin Bagheri Behzad , Hassan Niroomand , Mahbod Ebrahimi , Gholamreza Poormand , Firoozeh Akbari Asbagh,
Volume 73, Issue 9 (December 2015)
Abstract

Background: Infertility is defined as failure to achieve pregnancy after one year of unprotected sexual intercourse. Infertility can be related to male or female factors. Varicocele is the most common cause of infertility in men that is correctable with surgery. The purpose of this study was to determine the effects of recombinant follicle-stimulating hormone (rFSH) on semen parameters in infertile men.

Methods: This randomized clinical trial was done on 96 infertile men admitted to the Women's General Hospital Mohebe-Yas from September 2014 to September 2015. Inclusion criteria were to include varicocelectomy for unilateral idiopathic varicoceles and consent to participate in the study. Allergy to the drug combination and patient dissatisfaction were exclusion criteria. Patients participating in the study were divided into two groups randomly, one group received recombinant FSH three times a week and the other group received a placebo (normal saline) in the same way. After three months, the improvement of semen parameters, including motility, morphology and sperm count as well as the complications were determined in both groups. The data were analyzed with statistical software SPSS version 13 (Chicago, IL, USA).

Results: A total of 96 patients were enrolled in two groups of 48 men and women both groups were matched in terms of underlying factors. The rate of improvement in the morphology and motility of sperm in the treated group was significantly more than the placebo group (P= 0.0001) but the changes in sperm count were not significantly different between the groups (P= 0.495).

Conclusion: In summary, based on the results obtained in this study, it can be concluded that recombinant FSH is effective on improving semen parameters in infertile men after varicocelectomy compared with a placebo group and its major impact is on the morphology and motility of sperm.


The roles of Sertoli cells in fate determinations of spermatogonial stem cells
Maryam Khanehzad , Farid Abolhasani , Seyed Morteza Koruji , Iraj Ragerdi Kashani , Fereshteh Aliakbari ,
Volume 73, Issue 12 (March 2016)
Abstract

Background: Spermatogenesis is a complex and highly organized process of proliferation and differentiation of spermatogonial stem cells. Spermatogonial stem cells (SSCs) as a unique stem cell have the potential to self-renewal, differentiation and transmit genetic information to the next generation and play a vital role in maintaining fertility. Sertoli cells as the only somatic cells within the seminiferous epithelium play central roles in the formation of niche and balance between self-renewal and differentiation by secrete many growth factors. Given the importance and widespread use of SSCs, particularly in the treatment of infertility, the aim of this study was to create an optimal environment for the proliferation of SSCs. So we decided to study of undifferentiated (ID4) and differentiated (c-Kit) gene expression in SSCs followed by co-culture with Sertoli cells for a one-month.

Methods: This experimental study was conducted from November 2013 to December 2014 in Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, on immature NMRI mouse (6-3 days old). Initially, Sertoli cells and SSCs were isolated from neonates mouse testes during the two-step enzymatic digestion characteristics Sertoli cells with vimentin marker and SSCs with promyelocytic leukemia zinc-finger (PLZF) marker were confirmed. Then SSCs were cultured in two groups: co-culture with Sertoli and without co-culture (control). Undifferentiated (ID4) and differentiation (c-Kit) gene expression were evaluated by Real-time PCR technique.

Results: Spermatogonial stem cells purity was obtained 66.91% by flow cytometry. The relative expression levels of gene ID4 in co-culture group at the end of each week, compared to the control group showed a significant increase (P<0.05). While the expression of this gene significantly decreased in each group over time (P<0.05). The results of the comparison of the relative expression of c-Kit gene in co-culture group are indicated significant decrease than the control group at the end of each week (P<0.05). In addition, this gene expression was showed significant increase in each group individually over time (P<0.05) ID4 gene expression showed a significant (P<0.05) increase toward the control group, while in the expression of c-Kit was observed a significant (P<0.05) decrease compared with the control group at the end of each week.

Conclusion: According to the results of this study, co-culture with Sertoli cells maintains SSCs in the prolifration stage for long-term, so can be used to optimize the culture medium at the clinic.


Nano polyamidoamine-G7 dendrimer synthesis and assessment the antibacterial effect in vitro
Mitra Gholami , Shahram Nazari , Mahdi Farzadkia , Seyed Mohsen Mohseni , Soudabeh Alizadeh Matboo, Fakhraddin Akbari Dourbash , Meysam Hasannejad ,
Volume 74, Issue 1 (April 2016)
Abstract

Background: Nano scale dendrimers are macromolecules synthetic which frequently used in medical and health field. Because traditional antibiotics inevitably induce bacterial resistance, which is responsible for many treatment failures, there is an urgent need to develop novel antibiotic drugs. This study was aimed to examine Synthesis and the antibacterial effect of NanoPolyamidoamine-G7 (NPAMAM-G7) dendrimer on Escherichia Coli, Proteus Mirabilis, Salmonella Typhi, Bacillus Subtilis and Staphylococcus Aureus.

Methods: In this experimental study that has been conducted in June 2015 in the Laboratory of Microbiology, Iran University of Medical Science, NPAMAM-G7 dendrimers was synthesized by Tomalia’s divergent growth approach. The antibacterial effects of NPAMAM-G7 dendrimer were studied by disc diffusion and micro-dilution method. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) against gram-positive and gram-negative bacteria were determined according to Clinical and Laboratory Standards Institute (CLSI) guideline. Standard discs were prepared using different concentrations of dendrimer on Mueller-Hinton agar plates.

Results: Zone of inhibition in concentration 25 μg/ml of NPAMAM-G7 dendrimers for Escherichia Coli, Proteus Mirabilis, Salmonella Typhi, Bacillus Subtilis and Staphylococcus Aureus were 26, 38, 36, 22 and 25 mm, respectively. Regarding the zone of inhibition in gram negative bacteria with gram positive ones was P= 0.16 and was not significant difference. The MIC for Salmonella Typhi was 0.025, for Proteus Mirabilis, Bacillus Subtilis, Staphylococcus Aureus and Escherichia Coli was 0.25 μg/ml. The MBC for Salmonella Typhi was 25μg/ml, for Proteus Mirabilis and Bacillus Subtilis was 50 μg/ml and for Escherichia Coli and Staphylococcus Aureus was 100 μg/ml. The least of sensitivity against NPAMAM-G7 related to Escherichia Coli and Staphylococcus Aureus and the most of sensitivity related to Salmonella Typhi.

Conclusion: The NPAMAM-G7 dendrimer with end amine groups exhibited a positive impact on the removal of standard strains, gram-positive and gram-negative bacteria. Therefore, it is possible to use these nanodendrimers as antibacterial in the future.


Clinical and paraclinical features and treatment response in children with acute osteomyelitis
Parvin Akbari Asbagh, Ali Zamani , Seyed Reza Raees Karami , Mohammad Mahdi Zahrabi , Yasamin Mohammadzadeh ,
Volume 74, Issue 5 (August 2016)
Abstract

Background: Acute osteomyelitis is one of pediatric emergency which can cause unpleasant complications among them. This is especially accurate if the diagnosis had been delayed or the treatment was inappropriate. There is some misunderstanding in the detection of patients’ hospital files and it’s difficult to detect the diagnostic and treatment malpractice. We performed an investigation of the clinical and paraclinical data in children with acute osteomyelitis.

Methods: We performed a retrospective cross-sectional study in pediatric department of Imam Khomeini University Hospital in Tehran, Iran, from April 1997 to March 2010. The hospital records of all neonates and children from 15 days old to 15 years old were investigated. Patients with any defect in records were excluded from the study. A total of 54 children were included in this study. A questionnaire including clinical features, paraclinical findings and treatment response was completed for all subjects by design's executer. Data were analyzed using the software package SPSS version 16 (IBM, Armonk, NY, USA).

Results: In general, 35 children were male and 19 children were female. The average of age was 5.89 years. Children were divided into 4 groups based on age (less than 2, 2-7, 7-12 and 12-15 years) that majority of them were less than 2 years old (38.9%). The most common symptom and sign were pain (46.3%) and swelling (88.8%) respectively in this study. The most primary presenting symptoms were pain (46.3%) and swelling (24.1%). The comparison of frequency ranges of fever between children younger than 2 years and children 2-15 years old demonstrated a significant different (14.3% vs 84.8%, respectively) (P= 0.001). Staphylococcus aureus was the most commonly isolated organism (73.5%). Thirty-two patients (59.2%) needed surgical procedures in addition to antibiotic therapy that had successful outcome in all cases. The average of treatment duration with intravenous antibiotic was 28.14±12.84 days.

Conclusion: More than half of the children with acute osteomyelitis didn't response to antibiotic therapy and they needed different types of surgeries.


The relationship between intake of macronutrients and vitamins involved in one carbon metabolism with breast cancer risk
Mahshid Hatami , Mohammad Esmaeil Akbari , Morteza Abdollahi , Marjan Ajami , Yasaman Jamshidinaeini , Sayed Hossein Davoodi ,
Volume 75, Issue 1 (April 2017)
Abstract

Background: Breast cancer is the most common cancer among females in the world. Identifying the nutrients that modify the risk of the disease is one of the key strategies for improving the quality of life and reducing treatment costs. Epidemiological studies support the role of macronutrients and vitamins involved in one carbon metabolism in the etiology of the disease. This study aimed in investigation of the relationship between the intake of macronutrients and vitamins involved in one carbon metabolism with breast cancer risk.

Methods: This case-control hospital base study was conducted at Shohada Hospital, Tehran from April to February 2015. Demographic data, physical activity level and nutrients’ intake from diet and supplements were collected through interview from 151 cases and 154 controls. Dietary intake was assessed by a valid and reliable 168-item semi-quantitative food frequency questionnaire. Then intake of macronutrients and B vitamins was assessed by Nutritionist 4 software (First Databank Inc., CA, USA). Comparing categorical variables between the two groups was done by Chi-squared test and the relationship between intake of studied nutrients and risk of breast cancer was determined using logistic regression test.

Results: There were no difference in age, menarche age, menopause age, body mass index (BMI), number of live births between two groups. But the difference in physical activity, energy intake, marital status, educational level, occupation, oral contraceptives use was significant (P< 0.001). After modifying the effects of confounding variables, the risk of breast cancer was significantly lower in the highest intake quartile category relative to the lowest quartile category for total protein, total fiber, intake of vitamins B2, B6, B12 and folate (Ptrend< 0.001). Before modifying the effects of confounding variables, the risk of breast cancer was significantly higher in the highest intake quartile category relative to the lowest quartile category for carbohydrate and fat; but after modifying the effects of confounding variables, results were not significant.

Conclusion: The results showed that high intake of protein, fiber, vitamins B2, B6, B12 and folate are associated with lower risk of breast cancer.


Analysis of the effective factors in physician’s truth telling to cancer patients in Iran
Razieh Akbari, Mehdi Aghili,
Volume 75, Issue 3 (June 2017)
Abstract

Background: Cancer is a major life-threatening disease that can evoke deep-rooted fear of death and sense of loss of hope. Even the word, cancer, has powerful connotations of anxiety, pain and suffering. Cancer has a great impact on patients’ lives, so the extent to which physicians should inform them of the diagnosis poses a difficult decision in clinical settings. Therefore, truth telling is one of the most important issues in patients- physicians’ relationship. Besides the ethical aspect, telling or not telling the truth has some legal aspects, therefore, it is important to know the effective factors and understand how to deal with this issue especially for incurable diseases such as cancer. Therefore, the aim of this research was to analyses the effective factors in physician’s truth telling to cancer-patients.

Methods: The samples of this descriptive and analytical study, (survey study) consist of 161 cancer-specialists from Tehran University of Medical Sciences who have been selected by simple random sampling method in 2015 and 2016. The data was obtained by survey approach and the data collected using a questionnaire. In order to evaluate the validity and reliability of the research, expert’s opinion and Cronbach alpha coefficient have been used. The questionnaire included scales designed to measure attitude, intention, subjective norms; perceived behavior control. Statistical package for social science software (SPSS) were used to analyses the data. T-test and ANOVA were used to compare groups.

Results: Fifty-nine hudred percent male and 41% female physicians took part in this study. The average age of the participants was 43.4±11.27 years. The best person for truth-telling was physician and psychologist. Results showed that there was no significant difference between attitudes of male and female specialist but there was significant difference between oncologist and non-oncologist tendency to tell the truth. Results also showed that there was difference between physician’s behaviors (average 8.87). There was difference between behavior of private and public-private sectors physicians (62.8).

Conclusion: Although the results show that there are differences in specialists’ attitude toward truth telling, it is not a good reason for not telling the truth. Although the physicians should consider several factors when telling the truth.

Evaluation of hospital accreditation method
Ali Mohammad Mosadeghrad , Ali Akbari Sari , Taraneh Yousefinezhadi ,
Volume 75, Issue 4 (July 2017)
Abstract
Background: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results (outputs/ outcome) by an independent professional accreditation body using pre-established optimum standards. Hospital accreditation has an important role in improving the quality, safety, effectiveness and efficacy of health care services. The effectiveness of an accreditation system depends on the quality and conformity of its methods, standards and surveyors. This study aimed to evaluate the hospital accreditation method from the perspective of Iranian hospital managers.
Methods: This descriptive, applied and cross-sectional study was carried out in 2015 using a valid and reliable questionnaire. The study population consisted of 914 hospital managers. Overall 547 hospital managers were surveyed through stratified random sampling. SPSS software was used for data analysis.
Results: Almost 71.7 percent of hospitals achieved grade one and above in the first round of national accreditation survey. The mean score of managers’ satisfaction of hospital accreditation method was 3.21±0.63 out of 5 (Average). About 38 percent of hospital managers were satisfied with the hospital accreditation method. Most complaints were related to lack of reliability among surveyors and their low knowledge,  skills and experience. Hospital managers were satisfied with surveyors’ attitude and adequacy of the number of survey days. Hospital managers mostly believed that accreditation is better to be done by Ministry of Health, compulsory, and every two years. About 95 percent of hospital managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey.
Conclusion: Hospital managers were moderately satisfied with the national accreditation system. Developing job description and person specification for accreditation surveyors and recruiting them accordingly, and providing professional education and training for them help improve the effectiveness of Iranian hospital accreditation method. The method of hospital accreditation in Iran has to be changed. Self-assessment, unannounced surveys, review of hospital key performance indicators and patient satisfaction surveys should be added to the current scheduled on-site surveys to enhance the credibility of the accreditation result.

Duration of kangaroo mother care and weight gain in very low birth weight preterm infant
Mohsen Haghshenas Mojaveri , Zahra Akbarian Rad , Zeynab Shafipour , Somayeh Alizadeh Rokni , Fatemeh Valizadeh ,
Volume 75, Issue 11 (February 2018)
Abstract
Background: One of the important effects of kangaroo mother care (KMC) in preterm baby is improvement in weight gain and so shortening in hospitalization, but it is not clear that how long of kangaroo mother care is effective in weight gain. The aim of this study was to determine the least effective duration of kangaroo mother care in weight gain in very low birth weights.
Methods: Preterm babies with birth weight less than 1500 gr, without chronic cardiopulmonary disease, congenital anomaly and other medical problem when receiving to 140 ml/kg/d enteral feeding enrolled the study. KMC was started when the baby has been stabled, on the mother’s appetency and ability at bedside. The mean daily weight gain in KMC period was compared with expected that (15 mg/kg/d) for the same baby. The babies with KMC≥ 7 days were divided in three groups on the basis of mean daily KMC duration (< 30 min, 30-60 min and> 60). Statistical study performed by using SPSS software, version 22 (IBM SPSS, Armonk, NY, USA) and P values of less than 0.05 were considered to be significant.
Results: In this study, 103 preterm baby (47 boys, 56 girls) less than 1500 gr were enrolled, with mean birth weight 1107.85±190.87 gr. Mean weight gain of boys in KMC period and expected that were 324.78±162.66 gr Vs. 127.46±54.66 gr (P< 0.001). In eighty-seven babies who received KMC (7-40 days) mean daily weight gain was 26.69±15.55 gr (P< 0.001). Mean weight gain in KMC period for group with< 30 min (n=19), 402.63±126.29 gr Vs. 167.21±74.20 (P< 0.001), group with 30-60 min (n=54) were 338.79±182.60 gr Vs. 220.36±66.98 (P< 0.001) and group with 60< (n=14) 352.14±236.02 gr Vs. 259.96±112.23 (P= 0.09).
Conclusion: On the basis of this study KMC less than 1 hour per day is effective in weight gain of very low birth weight preterm babies.

Induction of labor in term pregnancy: sublingual versus buccal misoprostol
Ezat-Sadat Haj-Seyed Javadi , Farideh Movahed, Razieh Akbari,
Volume 76, Issue 4 (July 2018)
Abstract
Background: Labor induction is one of the most public ways carried out global for delivering mothers. The aim of labor induction is to encourage uterine contractions before the spontaneous onset of labor, resultant in vaginal delivery misoprostol is used off-label for a variety of indications in the practice of obstetrics and gynecology, including medication abortion, medical management of miscarriage, induction of labor, cervical ripening before surgical procedures, and the treatment of postpartum hemorrhage. Regarding the importance and lack of similar researches in Iran, this research was done to compare the efficacy of buccal and sublingual misoprostol for labor induction in pregnant women.
Methods: This study was conducted as a randomized double-blind clinical trial from March 2017 to February 2018. In this survey, 200 women were randomly assigned to receive 50 µg buccal misoprostol and sublingual (100 buccal and 100 sublingual) in Kosar Hospital, Qazvin University of Medical Sciences, Iran. The maternal and fetal complications, Bishop score, and time of pain onset and its interval with labor were monitored in two groups and the findings were analyzed.
Results: Research variables were age, gestational age, BMI, number of previous pregnancy, neonatal weight, total dose, Bishop score 1, Bishop score 6, oxytocin, and delivery type. The results showed that there were no differences between Bishop score 6 (P=0.07), and 1 (P=0.36), total dose (P=0.58), neonatal weight (P=0.43), number of pregnancy (P=0.67), BMI (P=0.67), and pregnancy weak (P=0.108) of sublingual group and buccal group. About 43 patients (43%) in buccal and 64 (64%) in sublingual group had vaginal delivery (P=0.05). The frequencies of maternal and fetal complications were similar between two groups.
Conclusion: It can be concluded that there is no difference between efficacy of sublingual and buccal misoprostol in pregnancy results, maternal, and fetal complications, however, it seems that the sublingual group is more effective than buccal group due to the significant amount of vaginal delivery, achieving vaginal delivery in less than 24 hours, and less need for oxytocin.

Evaluation of hospital accreditation in Tehran: brief report
Ali Mohammad Mosadeghrad , Ali Akbari-Sari , Taraneh Yousefinezhadi ,
Volume 76, Issue 5 (August 2018)
Abstract
Background: Hospital accreditation is a systematic external evaluation of a hospital’s structures, processes and results by an independent professional accreditation body using pre-established optimum standards. This study aimed to evaluate the hospital accreditation system.
Methods: This descriptive and cross-sectional study was carried out between November 2015 and February 2016 using a questionnaire covering accreditation standards, methods, surveyors, implementation and effects. The study population consisted of 161 hospital managers in Tehran province, Iran. Overall 87 hospital managers were surveyed through stratified random sampling.
Results: The mean score of managers’ satisfaction of hospital accreditation system was 2.93 out of 5 score. About 16 percent of managers were satisfied with the hospital accreditation system. Hospital managers were most satisfied with accreditation effects (3.14) and least satisfied with accreditation standards (2.54). Hospital managers were satisfied with surveyors’ attitude, number of survey days and the number of surveyors in the accreditation team. They were least satisfied with the lack of consistency among surveyors, lack of transparency of standards, too many standards and low competency of surveyors. Hospital managers mostly believed that accreditation should be done by Ministry of Health, compulsory, and every two years. About 97 percent of managers agreed that self-assessment is necessary and beneficial prior to the accreditation survey.
Conclusion: Accreditation was moderately successful in Tehran hospitals. Accreditation had the most effect on improving patient safety and meeting patients' rights and least effect on improving employees' job satisfaction and involving doctors in quality improvement. Strengthening Iran hospital accreditation system, training managers and employees on implementing standards, and providing necessary resources make it possible to achieve accreditation goals.

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