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Predisposing factors to development of mitral regurgitation and valve area
A Kazemi Khaledi ,
Volume 57, Issue 2 (5-1999)
Abstract
Background: Percutaneous Transeptal Mitral Commisurotomy (PTMC) has been used in treating mitral stenosis with variable success, its main complication being mitral incompetence. There is a need to define the subgroup of the patients who benefit mostly from the procedure. Methods: We studied 110 patients (age 17 to 60 years mean 33.2) with mitral stenosis. PTMC was performed though femoral vein. All patients underwent echocardiographic evaluation, both before and after the procedure. Clinical, hemodynamic and echocardiographic data were gathered and used to predict the outcome. Results: PTMC was successful in all 110 patients in alleviating the stenosis (mean transmitral gradient before procedure was 17.1 mmHg after procedure 4.4 mmHg). There was no mortality or major complication other than occurrence of mitral regurgitation in 9 cases. In this group only one patient subsequently needed a mitral valve replacement operation. The following parameters were found to have a significant correlation with the success rate of PTMC: lower age, shorter duration of illness, functional class III and IV, larger EF slope, smaller EPSS, smaller amplitude of valve motion, limitation of the posterior leaflet motion and negative history for open commisurotomy. The incidence of mitral regurgitation after procedure was found to be correlated with: atrial fibrillation rhythm before PTMC, lower age, longer duration of illness, more frequent relapse of rheumatic fever, functional class III and IV, less EF slope, limitation of the valve motion, larger left atrium, calcification of posterior leaflet and subvalvular extension. Conclusions: Balloon Mitral Valvuloplasty is an effective and relatively safe procedure in the management of the mitral stenosis. With the proper selection of the patients with the favorable outcome parameters, the rate of complication can be reduced.
The diagnosis of Pneumocystis Carinii pneumonia by new laboratory methods
N Rahimifard , M Ahi , A Kahnamooei ,
Volume 57, Issue 4 (7-1999)
Abstract
The object of this study was to find a suitable staining method for P.carinii. This parasite is not easily stained and clinical signs are not specific for the diagnosis of P.carinii pneumonia and therefore optimal laboratory methods for observing the organism are extremely valuable. In all 17 new conventional and modified staining techniques were used on lung impression smears and tissue section of sprague Dawley Rat treated with cortisone. Of these methods modified methylene blue 1 & 2, modified cresy violet 1, 2, 3, 4 modified Gram, modified Giemsa 2 and modified Griedley techniques have not previously been reported. After comparing readability of the slides, ease of performances, rapidity, availability and sensitivity of these 17 techniques for the diagnosis of P.carinii pneumonia, modified toluidine blue 01 & 2, modified methylene blue 1 & 2 and modified cresyl violet 3, 4 are suggested as the methods of choice for the rapid diagnosis of P.carinii pneumonia.
The effects of taking snacks on the learning ability and educational achievement of elementary school children, 1997-98
Sm Alavi Naeini , Sa Jazayeri , N Moghaddam Banaem , Gh.a Afrooz , Behboodi,
Volume 58, Issue 1 (4-2000)
Abstract
The effects of taking snacks on the learning ability and educational achievement of elementary school children in district 18 of Tehran educational organization were examined in the school year 1997-98. Other factors such as grade, nutritional status, breakfast eating habits and snack eating habits in the school were also studied. For this purpose 236 boys were selected by random sampling in 4 different schools. The children were randomly assigned to a group, with a low calorie snack (119 subjects), and a low-calorie control group (117 subjects), and then given 3 cognitive functions tests. The test were repeated after 4 months. The data were collected by questionnaires and included family socio-economic conditions, nutritional status and dietary habit of the children. Also, the grades of the major courses and scores of cognitive tests were collected, and the effects of treatment on the mean grades and scores differences were determined by T-test and analysis of variance (ANOVA). Our findings are presented as follow: The experimental and control groups were similar in the initial assessment. 7.1% of the students were stunted based on height-for-age classification (NCHS). The intervention led to an increase in tests scores, but the increase was only significant in the case of the short-term memory test (P<0.03). The findings of the study showed that the intervention was effective on short-term memory and since short-term memory function in memorization process and retrieval of subjects form long-term memory and congenitive functions, we can conclude that the food intervention with an energy lower than 10% of recommended dietary needs increases learning ability level of the subjects. Stunting and the habit of eating breakfast were related to educational performance of students. Therefore implementation of such programs in the community, such as food intervention and nutritional education may be effective.
A simple, low cost and fast improved fluorimetric method for Histamine measurement
Z Poorpak, P Gazorani , A Ahmadiani, A Kazem Zadeh,
Volume 59, Issue 6 (11-2001)
Abstract
The well-known fluorimetric method for histamine measurement which is one of the common methods in diagnostic laboratories was modified to accelerate and facilitate measurement of serum histamine levels and decrease the costs and restrictions. The modified method needs only 1 ml of whole blood (or serum) instead of about 10 ml in original method which is difficult almost or impossible specially for children. In addition, very small amounts of the expensive materials are needed and the samples are saved for about 15 days in -20°C which makes no significant changes. Because in most cases, sample can not be read at sampling day, the saving possibility is an advantage for improved method.
The method of choice in measurement of microproteinuria in developing countries
Khatami Z, Roohi S, Nami A, Shakeri N, Abbassi M ,
Volume 60, Issue 6 (9-2002)
Abstract

Introduction: In this study, we reviewuated and compared three routine methods for the measurement of urinary protein concentrations with a view to find a suitable method to prevent, diagnose and monitor renal disease under circumstances with limited resources.

Materials and Methods: Two modifications of the Trichoroacetic acid (TCA) turbidimetric method read at 405 and 620 nm and the sulfosalicylic acid (SSA) turbidimetric method were considered. The reviewuated was carried out using a variety of control materials, calibrators and patients urine samples.

Results: The result indicated that the TCA method read at 405nm is appropriate for the measurement of protein in the range of 25-700 mg/L and the TCA "620nm method" is appropriate for the measurement of protein concentration in the range of 100-1000 mg/L. Of the two methods, the TCA at 405 nm was minimally influenced by the type of calibrator. The SSA method showed unacceptable performance in the measurement of protein, specially at lower concentration, in addition the results showed a large variation depending on the type of calibration.

Conclusion: For screening of high-risk populations e.g. diabetics and early diagnosis of microproteinuria the recommended method is the TCA at 405 nm calibrated with a serum-based mixed Albumin/Globulin standard. For routine testing the TCA method at 620 is suggested regardless of type of calibration, although the limitations at lower concentrations should be remembered.


Spontaneous Pneumothorax Epidemiologic Characteristics And Treatment Methods In Iranian Patients(1992 - 002)
Mohebby H, Banna Zadeh, Panahi F, Bahrami H,
Volume 61, Issue 1 (4-2003)
Abstract
Spontaneous pneumothorax is a medical condition that potentially may be dangerous. Although several methods for management of this problem have been propounded, there is a great disagreement among the specialists about how to treat it and when more invasive treatments are indicated.
Materials and Methods: This study carried out in two phases. In first phase, 26 patients who had admitted to Imam Khomeini hospital from March 20, 1996 to March 19, 2000 and 50 patients admitted to Baqiatallah hospital between March 20, 1992 and March 19, 2002 with the diagnosis of spontaneous pneumothorax were studied retrospectively. In second phase, these patients were followed up.
Results: 39 patients (51.3%) had primary spontaneous pneumothorax, 35 patients (46.1%) secondary spontaneous pneumothorax and 2 (2.6%) neonatal spontaneous pneumothorax. 67 patients were male and 9 patients were female (male to female ratio: 7.5/1). Mean age of the patients was 35±20 years. Age peaks were the age group between 20 to 25 years old and age group more than 60 years old. Conducted treatments were observation in 3.9%, simple aspiration in 2.6%, thoracostomy alone in 81.6%, thoracostomy and chemical pleurodesis in 2.6%, thoracotomy and mechanical pleurodesis in 3.9%, thoracotomy and pleurectomy in 5.3% of cases. Mean duration of hospitalization was 8.9±7.3 days. Relapse of pnemothorax was seen in 36.9% of the followed patients. Mortality was 17.4% and all died patients had secondary spontaneous pneumothorax.
Conclusion: It seems that the management of spontaneous pneumothorax should be re-evaluated and the exact indications for conservative or more invasive methods of treatment should be defined.
A Study Of Stress Distribution At The Cement Interface Of Metal Ceramic Restoration-Dentin By Finite ElementAnalysis
Emamieh M , Emamieh Sh,
Volume 61, Issue 2 (5-2003)
Abstract
 Since three decade ago, the application of the concept of finite element analysis (EEA) have received a keen interest among dental investigators. In practice the FEA provides detailed stress information regarding to a non-homogenious body such as craniofocal skeletal growth, tooth post ceramo-metal crowns and etc. The aim of this study was the determination of the influence of stress distribution at the cement interface of metal ceramic restoration-dentin.
Materials and Methods: An idealized metal-ceramic crown model was developed. The model was divided into very small segments. Various loading conditions was applied to the model. A super sap software was used for analyzing the stress distribution.
Results & Conclusion: The results of this study suggest that the higher shear stress was developed in the cervical region by two dimensional methods.




 


Comparison Of Hormonal And Non-Hormonal Contraceptive Method Effects On The Mothers Milk And Infants Growth Among Lactating Women
H R Sadeghi Poor , M Samarkhah , M Effat Panah , A Bahiraei , Sh Khaghani, R Ansari Toroghi ,
Volume 62, Issue 4 (7-2004)
Abstract

Background: This research was conducted for the purpose of determining the effect of hormonal and non-hormonal contraception on the mother milk and infants growth among lactating women received by south Tehran’s Health Centers. In this regard a broad spectrum study from December 2000 until February 2001 was done by Tehran university.

Materials and Methods: By sampling method, 200 lactating women were chosen randomly. They were divided into two groups according to their preferred method of contraception: 67 women chose hormonal method and 133 women chose non –hormonal method.

Results&Conclusion: During the time of the study on infants growth (increase in head circumstances, increase in height, increase in weight), There was no significant difference between the two groups. If we take the effect of contraceptive methods into consideration, the Triglyceride levels in non-hormonal group were increased considerably compared to the other group. Other ingredients were almost the same.


Assessment of TPS tumor marker with ELISA for early detection and monitoring of gastrointestinal cancers
Salehi Nodeh A.r, Ghaffori Sh, Alimohamadian M.h, Sarraf Nejad A, Mirshafiei A,
Volume 64, Issue 11 (10-2006)
Abstract
Background: TPS is one of the tumor markers which has specially been considered due to its exclusive physiological characteristics like its easy measurement in serum of cancer patients. This study has been due to evaluate the efficiency of this tumor marker in the prognosis, treatment control and follow up of patients with gastrointestinal cancers including esophagus, stomach and colorectal.
Methods: TPS has been measured in 109 persons including 28 healthy people and 81 patients with different gastrointestinal malignancies which were composed of 38 patients with esophageal cancer, 20 ones with stomach cancer and 23 ones with colorectal cancer. Sampling has been done in three times depending on treatment methods. TPS has been measured with ELISA in samples which contend of 2 to 3 ml of serum from patients and the health.
Results: The obtained results, demonstrate the obvious changes in TPS serum level in patients underwent various treatment procedures.
 Conclusion: The results have revealed that the serum TPS is not only as a measure of prognosis but also would be helpful in follow up and treatment control of the disease. Moreover the results has shown that serological analysis can be settled in the diagnosis and follow up with production of polyclonal antibody against TPS gene family and planning appropriate pattern.
Non-surgical female sterilization with quinacrine-induced tubal occlusion: a clinical trial
L Seifi, F Ramezanzadeh, M Jafarabadi, M Shariat, M Masumi,
Volume 66, Issue 5 (8-2008)
Abstract
Background: Over the last 35 years, quinacrine has been used to sterilize more than 150,000 women in 40 countries, first in the form of slurry and now in the form of cylindrical pellets. Some studies confirmed the tubal occlusion by hysterosalpyngo-graphy, but this method increases the chance of failure. Only a few studies on tubal occlusion have used transvaginal sonography for confirmation, and there were some doubts about the effect of quinacrine on the endometrium. We performed this study to evaluate the tubal scar and endometrial pattern by ultrasound and to determine the feasibility, acceptance, and side effects of quinacrine sterilization (QS) in Iranian women
Methods: This prospective clinical trial was done at the Vali-e-Asr Reproductive Health Research Center of the Tehran University of Medical Sciences between April 2005 and July 2006. One hundred sexually active women ranging from 30 to 47 years of age, who had at least two children above two years old, requesting sterilization, were sterilized by this method. By the end of menstrual bleeding, seven pellets, each containing 36mg quinacrine, were inserted in the uterine fundal area via the cervical canal. The procedure was repeated one month later. Three cycles after the first step, transvaginal sonography was performed to visualize the tubal scar and determine the endometrial pattern. Patients were followed at one and three years after initiation of the procedure.
Results: All women were satisfied with the procedure. There were no side effects. No pregnancies had occurred, nor were there endometrial thickness abnormalities. Scar formation was visible in the tubes. Conclusion: Quinacrine sterilization is a useful method for women and can be recommended to family planning services as an ambulatory procedure due to its efficacy, simplicity, acceptance and cost effectiveness.
Ectopic pregnancy after two times tubal ligation: a case report
Farideh Keypour , Ilana Naghi ,
Volume 71, Issue 3 (6-2013)
Abstract
Background: Tubal sterilization is the permanent and effective contraception method. This can be performed at any time, but at least half are performed in conjunction with cesarean or vaginal delivery and are termed puerperal. The most complication after tubal ligation is ectopic pregnancy. Ectopic pregnancy is the leading cause of maternal death in first trimester.
Case presentation: We present a 33 years old woman gravida5, para4, all normal vaginal delivery, presented with complaints of delayed menstrual period, pelvic pain and spotting. She underwent tubal ligation for two times. For the first time she had puerperal Pomeroy tubal sterilization after third child delivery. Intra uterine pregnancy occurred three years later. One day after vaginal delivery of fourth child, she underwent post partum tubal ligation with the Parkland method. Tubal pregnancy occurred nine months later. Physical examination identified acute abdomen. Pelvic ultrasound showed no gestational sac in uterine cavity. The sac with fetal pole was in right adnexa. Beta-HCG was 2840mIU/ml. She underwent laparotomy. Surgical management included salpingectomy with cornual resection in both sides. The surgery identified Ectopic pregnancy.
Conclusion: Any symptoms of pregnancy in a woman after tubal ligation must be investigated an ectopic pregnancy should be excluded. Ectopic pregnancy must be considered, in any woman with lower abdominal pain, missed period and vaginal bleed-ing. Conception after tubal sterilization can be explained by fistula formation and re-canalization of fallopian tube.

The effects of lactobacillus suppositories in the recovery and recur-rence of bacterial vaginosis: a double-blind randomized clinical trial
Soror Roozafzay , Khadijeh Hekmat , Kobra Shojaei , Pourandokht Afshari , Mohammad Bahadoram ,
Volume 72, Issue 5 (8-2014)
Abstract
Background: Bacterial vaginosis (BV) is the most prevalent causes of abnormal secre-tion in women at fertility age. Also, Bacterial vaginosis is one of the most common dis-eases in women who refer to gynecology clinic. The main cause of the pathogenesis is increasing pH of vagina due to reduced number of lactobacillus and growth of anaero-bic bacteria. Prevalence of BV varies between 10 to 30 percent in different societies. Amsel criteria is used as diagnostic test in BV. This interventional study was designed to assess the impact of vaginal lactobacillus suppository and metronidazole compared to metronidazole alone on the recovery and recurrence of bacterial vaginosis. Methods: This study was a prospective, randomized, double-blind clinical trial which was conducted on 130 women with bacterial vaginosis to compare the effects of vagi-nal lactobacillus suppository and metronidazole. Bacterial vaginosis was diagnosed us-ing Amsel criteria that based on some clinical symptoms. Patients were divided into two groups, first group were treated with oral metronidazole plus lactobacillus and second group were treated with metronidazole alone. Patients were followed-up one week and four weeks after initiation of the treatment. Results: One hundred and thirty women completed the study. Patients were followed at one and four weeks after initiation of intervention. Amsel criteria and recovery rate in both groups compared before treatment one and four weeks after treatment. The crite-ria and treatment were significantly improved, but this improvement was higher and statistically significant in the metronidazole plus Lactobacillus group compared to sec-ond group (P< 0.0001). Conclusion: The protective effects of lactobacillus in dealing with anaerobic patho-gens as well as the negative impact of metronidazole on lactobacillus of vaginal flora, use of lactobacillus along with metronidazole especially in patients with recurrent infec-tions is recommended. In other words, using lactobacillus with metronidazole for treatment of bacterial vaginosis is more effective than metronidazole alone.
Detection of toxigenic bacillus cereus strains in powdered infant formula (PIF) milk by PCR assay
Mohammad Mehdi Soltan Dallal, Shirin Nezamabadi, Jalal Mardaneh, Zahra Rajabi, Abolfazl Sirdani,
Volume 75, Issue 3 (6-2017)
Abstract

Background: In recent years, use of powdered infant formula (PIF) milk for neonates feed is increasing; therefore, the quality control (QC) of PIF products is very important. The aim of present study was detection of toxigenic Bacillus cereus species in PIF milk using PCR assay.

Methods: The cross-sectional study was carried out on 125 samples of powdered infant formula milk (PIF) purchased between March 2015 and April 2016 in Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. Briefly, 0.1 dilutions were prepared and inoculated on Bacillus cereus selective media (MYP) and incubated at 30 °C for 24 hours. The suspicious colonies were verified using biochemical tests based on standard methods. Final confirmation of studied isolates was carried out by ITS gene detection using polymerase chain reaction (PCR) assay. Presence of nonhemolytic enterotoxin (NHE) (linked to diarrhoea syndrome) and emetic toxin (EM) (linked to emetic syndrome) virulence genes were investigated using polymerase chain reaction assay. 

Results: In this study, of 125 PIF samples, 84 (67.2%) were contaminated. Of various recovered bacteria from these samples, 110 bacterial isolates were suspected to be Bacillus spp. using phenotypic methods. The ITS PCR results showed that 91.8% of the isolates were B. cereus. Respectively, 53.63 and 79% of B. cereus isolates possessed NHE and EM virulence genes.

Conclusion: Our data revealed that near 80% of Bacillus cereus isolates have emetic toxin (EM) gene, as result virulence potency of this isolates is very high. However, the low number of this organisms in foods is very important and food safety protocols for these opportunistic toxigenic bacteria should be revised. Since the pasteurization process is ineffective on B. cereus spores; therefore, spores can remain in PIF milk and the vegetative bacterial cells can cause food poisoning in neonates. Therefore, modification of foods quality control protocols is essential in order to identify virulence genes in this bacterium.


Evaluation of hospital accreditation method
Ali Mohammad Mosadeghrad , Ali Akbari Sari , Taraneh Yousefinezhadi ,
Volume 75, Issue 4 (7-2017)
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.

Identification of Candida species by molecular and mycological methods in pregnant women with vulvovaginal candidiasis
Nahid Arefi Lisar , Parivash Kordbacheh , Sasan Rezaie , Mahin Safara , Roshanak Daie Ghazvini , Heidar Bakhshi , Zahra Omidvar Jalali ,
Volume 75, Issue 12 (3-2018)
Abstract
Background: Vaginal candidiasis is common in during pregnancy. It may lead to complications like abortions, premature birth, low birth weight, chorioamnionitis and fungal systemic neonatal infection. The aim of present study was identification of Candida species by mycological and molecular methods in pregnant women with vaginal candidiasis.
Methods: This cross-sectional study was performed on 80 pregnant women with or without clinical symptoms of vulvovaginal candidiasis referred to Shahid Noorani Talesh Hospital, Gilan University of Medical Sciences, Iran, from April to December 2015 (8 months). All specimens were examined by direct microscopy and culture on CHROMagar Candida medium for isolation and differentiation of major clinical-significant Candida species (spp.). Cultured media were incubated at 35 °C for 48 hours and evaluated based on color and number of grown colonies. If no growth was observed, the media were incubated for several additional days. Subcultures were done on Sabouraud dextrose agar (Merck, Germany) and Corn meal agar with Tween 80 media (Micromedia, Hungary) for further study. Identification of Candida spp. carried out by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method.
Results: In this study, vulvovaginal candidiasis was observed in 20 (25%) patients. Twenty-two isolates were obtained from culture of specimens on CHROMagar Candida medium (Paris, France). The most common isolated species was Candida albicans 16 (72.8%) and followed by Candida glabrata 5 (22.7%), Candida tropicalis 3 (13.6%) and Candida krusei 1 (4.5%) cases. Two patients had mixed infection with 2 different Candida species (C. albicans and C. glabrata) While using PCR-RFLP method, the Candida species were identified as 13 (59.1%) Candida albicans, 5 (22.7%) Candida glabra, 3 (13.6%) Candida tropicalis and 1 (4.5%) Candida krusei cases, respectively. In direct examination were seen yeast budding cells and pseudohyphae in 8 culture positive specimens. In the present study, results of conventional mycological method in differentiation of Candida spp. were consistent with molecular results in 80% of cases. There was also significant correlation between vulvovaginal candidiasis with clinical symptoms (P<0.0001), including diabetes mellitus (P<0.014), and taking antibacterial drugs (P<0.003) in pregnant women.
Conclusion: PCR-RFLP was able to identify correctly the Candida spp. as a complementary method.

Targeted cancer therapy: review article
Mohammadreza Noori-Daloii , Bahareh Kashani ,
Volume 76, Issue 4 (7-2018)
Abstract
Cancer is one of the most dangerous health problems of today modern societies which has an increasing rate especially in developing countries. There are many diverse ongoing treatment attempts trying to defeat cancer. Despite that, scientists have been unable to find a permanent cure for this disease. In many cases although there is a successful first response in patients, cancer cells are finally able to withstand therapeutic procedures and even use chemo-resistance to take advantage of treatments to facilitate tumor growth, resulting in cancer remission. Therefore, and mostly in recent two decades, scientists have been trying to choose their treatments just as smart to be able to conquer cancer. One of the best methods of this smart defense is to target weak points of neoplastic cells and use them for designing drugs. In this case it would be most probable for cancer cells not to have a chance to confront and cause chemo-resistance. Total endeavors to fulfill this goal are named “targeted cancer therapy”. This therapeutic approach is mostly consisted of two different procedures: 1- designing and using specific drugs to target cancer cells’ mutated genes; which will be defined by checking the genetic background of tumor cells for each specific cancer type. EGFR, RAS, VEGF and HIF-1α are among the pathways that have already been used as targets. 2- The other procedure could be methods that would carry drugs directly to unhealthy cells to prevent further side effects for normal cells of patients. It would be possible by designing specific antibodies to target antigens of neoplastic cells. Ribonucleic sequences (miRNAs and siRNAs) are also very promising as new drugs and nanoparticles have enabled us to increase drug concentration in tumors. The ultimate goal of these new experiments is to suggest specific drugs for each patient based on the nature of one's disease and genetic background, which will bring about "personalized medicine" era. Using valid new references, this review article first presents targets that are currently being used for this targeted therapy, their logic of choice and the drugs that have already been produced for clinical trials. Smart methods of drug delivery are also presented and discussed afterwards.

Measurement of pyruvate dehydrogenase enzyme in patients with diffuse large B-cell lymphoma relapse
Ali Hadi , Valiollah Mehrzad , Nazanin Vaziri , Lalaeh Shariati , Golnaz Vaseghi ,
Volume 78, Issue 2 (5-2020)
Abstract
Background: Diffuse large B-cell lymphoma (DLBCL) is the most common type of non-Hodgkin's lymphoma (NHL), which is the most common type of lymphoma. NHL comprises a group of clinically and biologically diverse diseases, which range from indolent to aggressive clinical courses. Despite treatment advances in the last three decades with the use of combination immunotherapy, a significant fraction of patients relapses or are refractory to these treatments. Actually, there is no standard method for detection of recurrence. The purpose of this study was to evaluate the level of this enzyme in the patients with recurrent DLBCL compared to healthy controls.
Methods: In this randomized double-blind, placebo-controlled trial, the serum level of pyruvate dehydrogenase (PDH) enzyme in total of 26 patients with DLBCL recurrence in compare with 26 healthy individuals in the Sayed Al-Shohada Hospital, Isfahan University of Medical Sciences in Iran from September 2016 to September 2018, were assessed. The clinical data including age criteria, the Eastern Cooperative Oncology Group (ECOG) score rating, total bilirubin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), prothrombin time and international normalized ratio (PT/INR), CT-scan, serum creatinine, platelet count, the absolute number of neutrophils, and the interval until the last treatment were gathered. After obtaining informed consent, blood samples were taken. and the PDH enzyme was measured in case and control groups.
Results: Fifty-three percent of patients were male and the mean age of participants in case and control groups was 37.2±17.3 and 34.8±8.9, respectively. Subsequently, the PDH levels were measured according to the enzyme protocol. The levels of enzyme in patients with relapse were significantly lower than normal ones (P=0.0003). The PDH serum level was also evaluated by age and sex, which did not show any significant differences (P=0.86). 
Conclusion: In patients with relapsing B-cell lymphoma, the pyruvate dehydrogenase (PDH) enzyme serum levels were significantly lower than healthy subjects, but this difference was not related to age and gender. In the case of further studies and comparisons beyond this study, this enzyme could be a good candidate, used as an alternative diagnosis tool, in patients with recurrent lymphoma.

Evaluation of cumulative kidney activity in pediatric nuclear scan of the bladder using conjugate view method and four different techniques for correcting background radiations
Mohammad Reza Salamat , Ali Ebrahimi, Masoud Moslehi,
Volume 79, Issue 7 (10-2021)
Abstract
Background: At present, in nuclear medicine to calculate the cumulative activity of various organs, different techniques are being used to correct the background radiations in the conjugate view method. Each of these techniques considers the effect and weight of background radiations to a different extent. These background radiations can cause errors in cumulative activity calculations. The purpose of this study was to evaluate and compare different techniques of correcting background radiations to each other in calculating kidney cumulative activity during the nuclear scan of the bladder in children.
Methods: This study was Cross-sectional and performed for patients who were referred to Isfahan Shahid Chamran Hospital between December 2019 and June 2020. In this study using Foley, 1 mCi of TC-DTPA radio-pharmaceutical that was diluted with normal saline was injected into the patient's bladder, then images recorded by gamma cameras were extracted at 2, 5, 10, and 20 minutes, Finally with ROI drawing around kidney with having vesicoureteral reflux, Cumulative renal activity was calculated with four correcting background radiations techniques such as without correction of background radiation, conventional method, Buijs method, and Kojima method Eventually, the data was Eventually, the data was compared to each other to determine how much weight each of these techniques consider for background radiations.
Results: Cumulative kidney activity after calculation with four correcting background radiations techniques such as without correction of background radiation, conventional method, Buijs method, and Kojima method were 14.970±4.776, 13.544±4.357, 13.885±4.451, 13.879±4.449 mCi.min. respectively After comparing the calculated cumulative activity without correcting the background radiations with the cumulative activity calculated by the three techniques of correcting the background radiations such as the conventional method, Buijs method, and Kojima method, the value (P<0.05) was obtained in all cases, which shows that elimination of background radiations is significantly meaningful in the calculations of cumulative activity in the conjugate method for nuclear exams
Conclusion: after comparing correcting background radiations techniques to each other, it was determined that the conventional method technique considers the effect and weight of background radiations more than the two other techniques such as the Buijs method and Kojima method in cumulative activity calculations.

Methodology of conceptual review in the health system
Ali Mohammad Mosadeghrad, Mahnaz Afshari, Fereshteh Karimi ,
Volume 80, Issue 1 (4-2022)
Abstract
Background: Conceptual review is a creative research method for generating new knowledge in the context of a vague and complex concept that helps to explain and clarify the concept, its components and its relation to related concepts. This study aimed to explain the methodology of conceptual review in the health system.
Methods: Articles related to the conceptual research method were searched and collected in four databases (i.e., PubMed, Scopus, Embase, Science Direct) and two search engines (e.g., Google and Google Scholar) between January 1950 and September 2021. Finally, 83 articles were selected for final review and analyzed through narrative analysis.
Results: This study was conducted using scoping review between October and December 2021. The conceptual review study is a systematic, scientific and objective inquiry that helps to identify and explain the dimensions, components, features and applications of a particular concept by defining, synthesizing and interpreting the findings of studies. It results in clarification of the meaning of concepts. An eight- steps protocol was introduced for conceptual review including concept selection, entry and exit criteria definition; selection of databases and search strategies; selection and reporting of studies using flowcharts; evaluating the validity of selected studies; extracting information about the definition, components, antecedents, consequences and evaluation criteria of the concept from selected studies, synthesizing data and developing a conceptual model and drawing conclusions from the synthesized findings. In addition, the structure of a conceptual review article was described and a checklist for evaluation of a conceptual review study was introduced.
Conclusion: A conceptual review study is a method that defines the concept by searching for scientific sources about a concept and their comprehensive review, explaining their characteristics, antecedents, consequences and applications to determine the position of the concept beyond their vocabulary definition. The conceptual review helps to develop existing theories by identifying the components of a complex concept and its antecedents and consequences and establishing a logical connection between them.

Presenting a model for assessing general medical students: a brief report
Neda Negahban Jouzan , Hossein Karimi Moonaghi , Hoorak Poorzand, Mohammad Khajedaluee,
Volume 81, Issue 1 (4-2023)
Abstract
Background: By examining the comprehensive system for evaluating the academic progress of general medical students, often the objectives of the cognitive domain and the form of cumulative evaluation were used, and the tests were not used much for feedback to the students. The aim of the study is to develop a model that fits the levels of Miller's evaluation pyramid in formative-cumulative forms.
Methods: The search was started in Iranian and international databases, magazines, curriculum of prestigious universities in the world. To find out about the latest events in the field of assessment, AMEE international virtual conferences in August 2021 and the summary booklet of medical education articles of Shahid Motahari 1400 (the 22nd national conference of medical education) were reviewed. Data analysis was done by Beredy's adaptive model. The search and analysis lasted for 11 months. Finally, a model was developed according to Miller's evaluation pyramid. Its validation was done in the focus group meeting in two ways, in person at Mashhad Medical School and virtual.
Results: According to the extracted data, the approach of assessment is towards formative assessment format and improvement of traditional methods along with modern methods, which was clearly observed in the study of the curriculum of Harvard-Stanford University in America and Oxford University in England. Integrating the results with Miller's evaluation levels, and the formative and cumulative evaluation format, led to the formulation of a model with the most favorable opinions of experts. In addition, the majority of opinions and suggestions of experts were related to the change in the way of executive policies of universities and providing a context for the emergence of new idea.
Conclusion: A model including measurement methods according to the levels of Miller's evaluation pyramid was developed in formative-cumulative. It is suggested that the model be reviewed by the relevant experts and notified by taking into account the implementation conditions for the correct evaluation process.

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