Isfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121Comparing the Effectiveness of Gradual Systematic Desensitization, Asser-tive Training Techniques and Their Combination for the Treatment of Stu-dents Suffering from Social Phobia DisorderComparing the Effectiveness of Gradual Systematic Desensitization, Asser-tive Training Techniques and Their Combination for the Treatment of Stu-dents Suffering from Social Phobia Disorder1089109813234FAHasanToozandehjaniAssistant Professor, Department of Educational Sciences, School of Humanities, Neyshabur Branch, Islamic Azad University, Mashhad, Iran.Journal Article20110206Introduction: Social phobia disorder is an example of anxiety disorders in which anxiety appears in some certain situatins or against special objects (out of his personality), while they are not dangerous. As a result, the person avoids these situations or objects seriously or endures them with intense anxiety.Methods: This semi experimental research was done to compare the effectiveness of gradual systematic desensitization and assertive training techniques and also their combination (in comparison with the control group) in the treatment of social phobia disorder. In this research thirty two people suffered from social phobia (between 18 and 22 years, both single and married) were chosen and divided to three treatment and control groups randomly. The main purpose of this research was to analyze the results of different therapeutic methods (curing methos) in treating social phobia in the end of relief period and to observe them in a period of three months after the relief. To gather data heeded, clinical interview and self-report forms were used. Then the data were analyzed by means of vair-lind-anlalysis and tuky-t tests.Finding: The curing methods of gradual systematic desensitization, assertive training and the combination of these two were effective only during the treatment period and their effectiveness reduces after treatment. Meanwhile, the combined therapy was more effective than each of them separately.Introduction: Social phobia disorder is an example of anxiety disorders in which anxiety appears in some certain situatins or against special objects (out of his personality), while they are not dangerous. As a result, the person avoids these situations or objects seriously or endures them with intense anxiety.Methods: This semi experimental research was done to compare the effectiveness of gradual systematic desensitization and assertive training techniques and also their combination (in comparison with the control group) in the treatment of social phobia disorder. In this research thirty two people suffered from social phobia (between 18 and 22 years, both single and married) were chosen and divided to three treatment and control groups randomly. The main purpose of this research was to analyze the results of different therapeutic methods (curing methos) in treating social phobia in the end of relief period and to observe them in a period of three months after the relief. To gather data heeded, clinical interview and self-report forms were used. Then the data were analyzed by means of vair-lind-anlalysis and tuky-t tests.Finding: The curing methods of gradual systematic desensitization, assertive training and the combination of these two were effective only during the treatment period and their effectiveness reduces after treatment. Meanwhile, the combined therapy was more effective than each of them separately.https://jims.mui.ac.ir/article_13234_b0e864a6eccfc779c8119f5a4468797f.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121A Comparative Study on the Therapeutic Effect of the Propolis Vaginal Cream and Clotrimazole on Candida Vulvovaginitis in Reproductive Aged WomenA Comparative Study on the Therapeutic Effect of the Propolis Vaginal Cream and Clotrimazole on Candida Vulvovaginitis in Reproductive Aged Women1099110713235FAMahsa SadatMousaviInstructor, Faculty Member, Department of Midwifery, School of Nursing and Midwifery, Khorasgan Branch, Islamic Azad University, Isfahan, Iran.TaherehKeshavarzInstructor, Faculty Member, Department of Midwifery, Fatemeh (PBUH) School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran.HashemMontaseriAssistant Professor, Department of Pharmaceutics, School of Pharmacology, Shiraz University of Medical Sciences, Shiraz, Iran.KeyvanPakshirAssociate Professor, Department of Parasitology and Mycology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.MaryamYazdaniAssociate Professor, Department of Obstetrics and Gynecology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.NajafZareAssociate Professor, Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.HooshangAfrouzanMSc, Honeybee Department, Animal Science Research Institute ,Karaj, Iran.Journal Article20110206Background: Candidiasis vulvoginitis is the second prevalent infection of the vagina; azole topical drugs are the most common methods of treatment. Due to the frequent recurrence of the disease, many women desire to use herbal therapy. Propolis is among these therapies which it's anti-fungal property has been proved. This study was carried out to compare the effect of Propolis vaginal cream with clotrimazole on the treatment results of candidiasis vulvoginitis in reproductive aged women .Methods: This clinical trial was conducted on 100 ladies at fertility age for a period of 8 months. From the viewpoint of clinical complaints and laboratory culture, all the patients were diagnosed to be afflicted and underwent treatment in two groups of 50 individuals each with clotrimazole and Propolis randomly. The results were compared after 10 days of therapy and reculturing.Finding: The itching and cheesy leukorrhea was recovered in 92.0% and 68.0% of the patients treated with clotrimazole and Propolis, respectively with a significant statistically diference. Propolis had a weak effect on the improvement of the patients' complaints as compared to clotimazole. From the viewpoint of the reduction of colony, no significant statistical difference was observed. That is, in reducing the colony, Propolis had the same effect as that of clotrimazole.Conclusion: Considering the same effect of both drugs in reducing the colony, Propolis can be used as a complimentary treatment besides the main therapy.Background: Candidiasis vulvoginitis is the second prevalent infection of the vagina; azole topical drugs are the most common methods of treatment. Due to the frequent recurrence of the disease, many women desire to use herbal therapy. Propolis is among these therapies which it's anti-fungal property has been proved. This study was carried out to compare the effect of Propolis vaginal cream with clotrimazole on the treatment results of candidiasis vulvoginitis in reproductive aged women .Methods: This clinical trial was conducted on 100 ladies at fertility age for a period of 8 months. From the viewpoint of clinical complaints and laboratory culture, all the patients were diagnosed to be afflicted and underwent treatment in two groups of 50 individuals each with clotrimazole and Propolis randomly. The results were compared after 10 days of therapy and reculturing.Finding: The itching and cheesy leukorrhea was recovered in 92.0% and 68.0% of the patients treated with clotrimazole and Propolis, respectively with a significant statistically diference. Propolis had a weak effect on the improvement of the patients' complaints as compared to clotimazole. From the viewpoint of the reduction of colony, no significant statistical difference was observed. That is, in reducing the colony, Propolis had the same effect as that of clotrimazole.Conclusion: Considering the same effect of both drugs in reducing the colony, Propolis can be used as a complimentary treatment besides the main therapy.https://jims.mui.ac.ir/article_13235_c1adc7e5ae982a010af2eb442b583640.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121Preventive Effect of Pumpkin (Cucurbita Pepo L.) on Diabetic index and Histopathology of Pancreas in Alloxan-Induced Diabetes in RatsPreventive Effect of Pumpkin (Cucurbita Pepo L.) on Diabetic index and Histopathology of Pancreas in Alloxan-Induced Diabetes in Rats1108111713236FASomayehKazemiDepartment of Biology, School of Science, The University of Isfahan, Isfahan, Iran.SedighehAsgariAssociate Professor, Isfahan Cardiovascular Research Center and Applied Physiology Research Center, Isfahan University of Medical Sciences, Isfahan, IranSeyed JamalMoshtaghianAssistant Professor, Department of Biology, School of Science, The University of Isfahan, Isfahan, Iran.MahmoudRafieianProfessor, Herb Research Center, Shahrekord University of Medical Sciences, Shahrekord, IranParvinMahzooniAssociate Professor, Department of Pathology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20110206Introduction: Nowadays, medicinal plants are novel therapeutic approaches in the treatment of diabetes. This study aimed at assessing preventive effect of different doses of Cucurbita pepo (Pumpkin) on blood glucose and insulin levels and pancreas tissue in rats with diabetes.Methods: In this experience male white Wistar rats were randomly divided into four groups of seven each: 1, normal group, 2, diabetic group, 3. preventive + low dose of pumpkin powder (1 g/kg) and 4. preventive + pumpkin powder (2g/kg). Groups 3 and 4 received pumpkin powder with gavage injection for 6 weeks, daily and were injected with alloxan (120 mg/kg) at the end of the second week. Fasting blood samples were collected before of injection of alloxan and at the end of experimental period. Pancreas tissue samples in all groups were collected to be microscopic investigated.Finding: There was no significant difference between the groups in level of fasting blood sugar and insulin before alloxan injection. The results indicated a significant decrease in fasting blood sugar and significant increase in insulin level in the treated groups with pumpkin powder compared to diabetic group. There was not any significant difference between function of the high and low dosages of pumpkin powder (P < 0.05). Histological studies of the pancreas tissue samples confirmed that on the base, the consumed pumpkin had significant effects on increasing the size of pancreatic islets. Conclusion: Based on these results, it is suggested that pumpkin powder consume has favorable effects in preventing hyperglycemia and the histopathological changes of pancreas in diabetes.Keywords: Diabetes, Cucurbita pepo, Pancreas, Histopathology, Alloxan monohydrate.Introduction: Nowadays, medicinal plants are novel therapeutic approaches in the treatment of diabetes. This study aimed at assessing preventive effect of different doses of Cucurbita pepo (Pumpkin) on blood glucose and insulin levels and pancreas tissue in rats with diabetes.Methods: In this experience male white Wistar rats were randomly divided into four groups of seven each: 1, normal group, 2, diabetic group, 3. preventive + low dose of pumpkin powder (1 g/kg) and 4. preventive + pumpkin powder (2g/kg). Groups 3 and 4 received pumpkin powder with gavage injection for 6 weeks, daily and were injected with alloxan (120 mg/kg) at the end of the second week. Fasting blood samples were collected before of injection of alloxan and at the end of experimental period. Pancreas tissue samples in all groups were collected to be microscopic investigated.Finding: There was no significant difference between the groups in level of fasting blood sugar and insulin before alloxan injection. The results indicated a significant decrease in fasting blood sugar and significant increase in insulin level in the treated groups with pumpkin powder compared to diabetic group. There was not any significant difference between function of the high and low dosages of pumpkin powder (P < 0.05). Histological studies of the pancreas tissue samples confirmed that on the base, the consumed pumpkin had significant effects on increasing the size of pancreatic islets. Conclusion: Based on these results, it is suggested that pumpkin powder consume has favorable effects in preventing hyperglycemia and the histopathological changes of pancreas in diabetes.Keywords: Diabetes, Cucurbita pepo, Pancreas, Histopathology, Alloxan monohydrate.https://jims.mui.ac.ir/article_13236_7507dafaedac784a18c852536bbd3c88.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121Is EuroSCORE Model an Appropriate Scale to Estimate the Mortality before the Coronary Bypass Surgery in Iranian Patients?Is EuroSCORE Model an Appropriate Scale to Estimate the Mortality before the Coronary Bypass Surgery in Iranian Patients?1118112513237FASeyed MohsenMir Mohammad SadeghiAssistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranAliEtesampourAssistant Professor, Department of Internal Medicine, School of Medicine, Najaf abad Branch, Islamic Azad University and Delasa 3 Research and Trapeutic Center, Isfahan, IranFatemeh SadatMir Mohammad SadeghiIntern, School of Medicine, Najaf abad Branch, Islamic Azad University, Isfahan, IranMojganGharipourCardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, IranMahmoudSaeediAssistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran0000-0002-4104-9324PeymanNilforoushDepartment of Angiography, Sina Hospital and Delasa Research and Trapeutic Center, Isfahan, IranZeynabShariatIntern, School of Medicine, Najaf abad Branch, Islamic Azad University, Isfahan, IranJournal Article20110206Background: Coronary Artery Bypass Surgery (CABG) is an effective and important treatment for patients with coronary artery disease. Nowadays, there is more interest in prediction of mortality and patient's outcome after cardiac surgery. Several models have been designed to detect related risk factors to patient's outcome. This study evaluated one of the most valid models, EuroSCORE in patients who have had CABG in Sina cardiac surgery center in Isfahan.Method: EuroSCORE's values were calculated for 1511 patients who had CABG. All of them were followed up after 30 days.Result: 30-days mortality was 3.6% in our patient. Age (P = 0.02), left ventricle dysfunction (P = 0.03) and neurological dysfunction (P = 0.03) were the most important risk factors in our patient. The area under the ROC curve was 0.66.Conclusion: EuroSCORE model in our patient can predict 66% of 30-days mortality after CABG correctly. Thus, making a local model with more power to predict post CABG mortality is necessary in our country.Background: Coronary Artery Bypass Surgery (CABG) is an effective and important treatment for patients with coronary artery disease. Nowadays, there is more interest in prediction of mortality and patient's outcome after cardiac surgery. Several models have been designed to detect related risk factors to patient's outcome. This study evaluated one of the most valid models, EuroSCORE in patients who have had CABG in Sina cardiac surgery center in Isfahan.Method: EuroSCORE's values were calculated for 1511 patients who had CABG. All of them were followed up after 30 days.Result: 30-days mortality was 3.6% in our patient. Age (P = 0.02), left ventricle dysfunction (P = 0.03) and neurological dysfunction (P = 0.03) were the most important risk factors in our patient. The area under the ROC curve was 0.66.Conclusion: EuroSCORE model in our patient can predict 66% of 30-days mortality after CABG correctly. Thus, making a local model with more power to predict post CABG mortality is necessary in our country.https://jims.mui.ac.ir/article_13237_3f258712c3ba708ba78a60afde94352a.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121Investigation about Involved Factors in Breast FeedingInvestigation about Involved Factors in Breast Feeding1126113913238FAOmidYaghiniAssistant Professor, Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.SomayehKhamehGeneral Practitioner, Isfahan, IranFarzaneDaneshIntern, School of Medicine, Isfahan University of Medical Sciences, Isfahan, IranMohammad RezaModaresiAssistant Professor, Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.HoseinSaneianAssistant Professor, Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20110206Background: There are many studies shown the advantages of breastfeeding, not only for the infant, but also for the mother. There is no doubt that breastfeeding carries many advantages. Mother's milk is more benefit than formula. Breastfeeding reduce the risk of post natal bleeding infectious disease, breast and ovarian cancer, iron deficiency anemia and even death. There are several factors influence exclusive breastfeeding in the first six month after birth. It is necessary that hygienic systems and mothers baby clinics do suitable proceeding to increase the rate of breastfeeding.Methods: This cross sectional study conducted in Isfahan urban health centers in 2008. The sample size was calculated by especial formula for prevalence study. In this study, we selected 656 children living in Isfahan by easy method. The data were analyzed by SPSS software using Student-t and chi-square test.Finding: 537 (819%) were fed by breastfeeding and 119 (18.1%) were fed by formula. In addition, 235 of boys (78.9%) and 301 of girls (84.3%) were feed by breastfeeding and the difference between two groups was not statistically significant. Many factors have positive role for breastfeeding such as mothers’ awareness mothers job, rank of birth, birth weight and etc and this factors must be noticed by responsibility of public health.Conclusion: This study showed the effect of some factors such as socioeconomic status of family, birth weight, type of delivery and etc in the breastfeeding.Background: There are many studies shown the advantages of breastfeeding, not only for the infant, but also for the mother. There is no doubt that breastfeeding carries many advantages. Mother's milk is more benefit than formula. Breastfeeding reduce the risk of post natal bleeding infectious disease, breast and ovarian cancer, iron deficiency anemia and even death. There are several factors influence exclusive breastfeeding in the first six month after birth. It is necessary that hygienic systems and mothers baby clinics do suitable proceeding to increase the rate of breastfeeding.Methods: This cross sectional study conducted in Isfahan urban health centers in 2008. The sample size was calculated by especial formula for prevalence study. In this study, we selected 656 children living in Isfahan by easy method. The data were analyzed by SPSS software using Student-t and chi-square test.Finding: 537 (819%) were fed by breastfeeding and 119 (18.1%) were fed by formula. In addition, 235 of boys (78.9%) and 301 of girls (84.3%) were feed by breastfeeding and the difference between two groups was not statistically significant. Many factors have positive role for breastfeeding such as mothers’ awareness mothers job, rank of birth, birth weight and etc and this factors must be noticed by responsibility of public health.Conclusion: This study showed the effect of some factors such as socioeconomic status of family, birth weight, type of delivery and etc in the breastfeeding.https://jims.mui.ac.ir/article_13238_0e762b65028402721e10bbc97ede52b7.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121Body Temperature using Oral Mercury Thermometer in Comparison to Infrared Tympanic ThermometerBody Temperature using Oral Mercury Thermometer in Comparison to Infrared Tympanic Thermometer1140114513239FAAlirezaEmami NaeiniAssociate Professor, Department of Infection Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.ElahehNazariGeneral Practitioner, Isfahan, Iran.SaharEmami NaeiniMedical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20110319Background: Standard method for measuring body temperature has relied on oral site by using mercury thermometers (MT). Infrared tympanic thermometry (ITT), which measures the flow of heat from the surface of tympanic membranes and ear canal, is increasingly used in clinical settings. The aim of this study was to determine the accuracy of measuring body temperature by infrared tympanic thermometry in comparison to oral mercury thermometers method.Methods: In a cross-sectional study, we measured body temperature (BT) of 124 patients (72 men and 52 women) admitted in infectious ward of Al-Zahra hospital, Isfahan, Iran, by using oral mercury thermometers and simultaneously by infrared tympanic thermometry from right and left ear canal.Finding: Mean infrared tympanic thermometry body temperature from right and left ear with and without cerumen had no significant statistical differences (P = 0.31 and P = 0.23 respectively). Mean oral mercury thermometers body temperature were 0.72 ± 0.59 and 0.93 ± 0.74 ºC less than infrared tympanic thermometry (P < 0.001).Conclusion: Sex, right and left ear and cerumen have no significant effect on infrared tympanic thermometry, but mean body temperature by using infrared tympanic thermometry method is lower than oral temperature. So, other bigger survey is recommended for determining the accuracy of this electronic body temperature measurement.Background: Standard method for measuring body temperature has relied on oral site by using mercury thermometers (MT). Infrared tympanic thermometry (ITT), which measures the flow of heat from the surface of tympanic membranes and ear canal, is increasingly used in clinical settings. The aim of this study was to determine the accuracy of measuring body temperature by infrared tympanic thermometry in comparison to oral mercury thermometers method.Methods: In a cross-sectional study, we measured body temperature (BT) of 124 patients (72 men and 52 women) admitted in infectious ward of Al-Zahra hospital, Isfahan, Iran, by using oral mercury thermometers and simultaneously by infrared tympanic thermometry from right and left ear canal.Finding: Mean infrared tympanic thermometry body temperature from right and left ear with and without cerumen had no significant statistical differences (P = 0.31 and P = 0.23 respectively). Mean oral mercury thermometers body temperature were 0.72 ± 0.59 and 0.93 ± 0.74 ºC less than infrared tympanic thermometry (P < 0.001).Conclusion: Sex, right and left ear and cerumen have no significant effect on infrared tympanic thermometry, but mean body temperature by using infrared tympanic thermometry method is lower than oral temperature. So, other bigger survey is recommended for determining the accuracy of this electronic body temperature measurement.https://jims.mui.ac.ir/article_13239_b980be726641e1ce5cfa8dde32ee3bcf.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121Prevalence of Dangerous Health Behaviors in Medical Emergency Wards of Teaching Hospitals in Isfahan, IranPrevalence of Dangerous Health Behaviors in Medical Emergency Wards of Teaching Hospitals in Isfahan, Iran1146115513240FAMojtabaRostamiAssociate Professor, Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.FatemehTehraniMedical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20110319Background: Nosocomial infections are very important among the health staff. Random and unexpected events such as piercing needle or sharp objects to the hand, spattering blood or body fluids to the eyes or mouth, and contact of the damaged skin with blood or body fluids without any protection put healthcare workers at the risk of such infections. This study aimed to determine relative frequency of risky health behaviors when dealing with medical emergencies among the educational hospitals’ staff.Methods: This was a cross-sectional study with non-probable simple sampling on 384 people among three university hospitals affiliated to Isfahan University of Medical Sciences including health workers, nurses, interns, and residents. Risky behaviors of the study subjects in the emergency unit were documented through direct observation in a questionnaire including name, gender, age, occupation, work experience, and hospital along with nine risky and imprudence actions. The results were analyzed through chi-square method.Finding: Lack of using proper gloves during emergency management observed 65.4%, lack of using a specific container for needle destruction (56.0%), and lack of using mask also observed 94.0%. 67% of the subjects during the emergency management turned back the needle cover to it. Relative frequency of hand contamination with blood, blood infusion, infection of the bed sheets, and unit and also piercing a sharp object to the hands during the emergency management respectively were 22.7, 4.2, 36.2 and 3.4 and 98.7 percent. Wearing gloves among women, younger staff, interns, the group with 1.1 to 5 years of experience, and Al-Zahra Hospital was more (P < 0.05). Needle restore coverage, lack of using a specific container for needle destruction, lack of using mask and piercing a sharp object to the hands were associated with age, occupation and work experience (P < 0.05). Regarding needle restore coverage and lack of using a specific container for needle destruction, increase in age was associated with high risk behavior and high level of education was associated with reducing risk behaviors. Increase in work experience was associated with needle restore coverage and using a specific container for needle destruction in the group with 1.1 to 5 years of experience was more prevalent than others. Piercing a sharp object to the hands was more occurred in younger staff and interns, and it also reduced by increasing the work experience. The younger staff, interns and novice groups were the subjects who used masks when it was required. Hand contamination with blood, blood infusion and not applying the appropriate disinfection method were associated with occupation of the subjects; so that all these high-risk behaviors were more prevalent among the health workers. Relative frequency of infection of the bed sheets and patient’s unit was more among the male staff, older staff and also among the interns and health workers.Conclusion: Relative frequency of health risky behaviors unacceptably was very high due to absence of standard precautions at the time of dealing with the medical emergencies in the educational hospitals affiliated to Isfahan University of Medical Sciences. Accessibility of protective facilities and informing programs would more help to follow these precautions.Background: Nosocomial infections are very important among the health staff. Random and unexpected events such as piercing needle or sharp objects to the hand, spattering blood or body fluids to the eyes or mouth, and contact of the damaged skin with blood or body fluids without any protection put healthcare workers at the risk of such infections. This study aimed to determine relative frequency of risky health behaviors when dealing with medical emergencies among the educational hospitals’ staff.Methods: This was a cross-sectional study with non-probable simple sampling on 384 people among three university hospitals affiliated to Isfahan University of Medical Sciences including health workers, nurses, interns, and residents. Risky behaviors of the study subjects in the emergency unit were documented through direct observation in a questionnaire including name, gender, age, occupation, work experience, and hospital along with nine risky and imprudence actions. The results were analyzed through chi-square method.Finding: Lack of using proper gloves during emergency management observed 65.4%, lack of using a specific container for needle destruction (56.0%), and lack of using mask also observed 94.0%. 67% of the subjects during the emergency management turned back the needle cover to it. Relative frequency of hand contamination with blood, blood infusion, infection of the bed sheets, and unit and also piercing a sharp object to the hands during the emergency management respectively were 22.7, 4.2, 36.2 and 3.4 and 98.7 percent. Wearing gloves among women, younger staff, interns, the group with 1.1 to 5 years of experience, and Al-Zahra Hospital was more (P < 0.05). Needle restore coverage, lack of using a specific container for needle destruction, lack of using mask and piercing a sharp object to the hands were associated with age, occupation and work experience (P < 0.05). Regarding needle restore coverage and lack of using a specific container for needle destruction, increase in age was associated with high risk behavior and high level of education was associated with reducing risk behaviors. Increase in work experience was associated with needle restore coverage and using a specific container for needle destruction in the group with 1.1 to 5 years of experience was more prevalent than others. Piercing a sharp object to the hands was more occurred in younger staff and interns, and it also reduced by increasing the work experience. The younger staff, interns and novice groups were the subjects who used masks when it was required. Hand contamination with blood, blood infusion and not applying the appropriate disinfection method were associated with occupation of the subjects; so that all these high-risk behaviors were more prevalent among the health workers. Relative frequency of infection of the bed sheets and patient’s unit was more among the male staff, older staff and also among the interns and health workers.Conclusion: Relative frequency of health risky behaviors unacceptably was very high due to absence of standard precautions at the time of dealing with the medical emergencies in the educational hospitals affiliated to Isfahan University of Medical Sciences. Accessibility of protective facilities and informing programs would more help to follow these precautions.https://jims.mui.ac.ir/article_13240_23d6c2965508b167da9c4bdcef3a2aa3.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121The Prevalence of Prostatic Cancer after Renal TransplantationThe Prevalence of Prostatic Cancer after Renal Transplantation1156115913241FAMohammadYazdaniAssociate Professor, Department of Urology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.RahimJorjaniMedical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20110319Background: This study aimed to evaluate the prevalence of prostatic cancer after renal transplantation and its correlation with underlying etiology of renal failure, immunosuppressive compounds, and renal function after transplantation in comparison with normal population.Methods: In this cross-sectional study, 185 male renal transplant recipients, aged more than 40 years were entered. They were evaluated by digital rectal examination and free and total Prostat-specific antigene (PSA) levels were measured for them. They would have undergone prostatic biopsy under trans-rectal-ultrasonography if they had suspicious digital rectal examination, total PSA > 2.1 ng/ml or free/total PSA ≤ 0.15.Finding: None of patients had the criteria of prostatic biopsy. The mean age of patients was 56.2 ± 8.9 years and the largest age group was 50-59. The mean of PSA level was 0.88 ± 0.48 ng/ml; the minimum and maximum were 0.1 and 2 ng/ml, respectively. The mean, minimum, and maximum of free/total PSA were 0.46 ± 0.22, 0.2, and 1 respectively.Conclusion: In this study, none of patients were candidate for prostatic biopsy. Prolonged studies with regular follow-up are recommended. Background: This study aimed to evaluate the prevalence of prostatic cancer after renal transplantation and its correlation with underlying etiology of renal failure, immunosuppressive compounds, and renal function after transplantation in comparison with normal population.Methods: In this cross-sectional study, 185 male renal transplant recipients, aged more than 40 years were entered. They were evaluated by digital rectal examination and free and total Prostat-specific antigene (PSA) levels were measured for them. They would have undergone prostatic biopsy under trans-rectal-ultrasonography if they had suspicious digital rectal examination, total PSA > 2.1 ng/ml or free/total PSA ≤ 0.15.Finding: None of patients had the criteria of prostatic biopsy. The mean age of patients was 56.2 ± 8.9 years and the largest age group was 50-59. The mean of PSA level was 0.88 ± 0.48 ng/ml; the minimum and maximum were 0.1 and 2 ng/ml, respectively. The mean, minimum, and maximum of free/total PSA were 0.46 ± 0.22, 0.2, and 1 respectively.Conclusion: In this study, none of patients were candidate for prostatic biopsy. Prolonged studies with regular follow-up are recommended. https://jims.mui.ac.ir/article_13241_e1241d1b9692c1e9f4ebbf6896f0e33e.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121Frequency and Distribution of Cardiovascular Changes as well as Consciousness Alterations in Patients with Carbamazepine ToxicityFrequency and Distribution of Cardiovascular Changes as well as Consciousness Alterations in Patients with Carbamazepine Toxicity1160116713242FAFarzadGheshlaghiAssistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0002-8972-7366AhmadYaraghiAssistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0001-8532-9005AshkanGhoreishiMedical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20110319Background: Due to significant effects of carbamazepine toxicity on the cardiovascular system and the present contraversy about the frequency of cardiovascular manifestations in such patients, this study was designed to evaluate this issue more throughly.Methods: In a cross-sectional study, patients with carbamazepine poisoning referred to Nour Hospital, Isfahan, were recruited using convinience sampling method. ECG parameters (QRS complex, QT interval, and PR interval), pulse rate, and blood pressure changes, as well as consciousness alterations, were measured in patients on admission and 12 and 24 hours later.Finding: Among 77 patients 49 (63.6%) were women. There was no significant relationship between QT interval and QRS complex changes and pulse rate alteration and carbamazepine toxicity; but there was meaningful association between pulse rate, blood pressure (systolic and diastolic), and PR interval changes. Furtheremore, there was significant decreasing relationship between loss of consciousness (coma) and blood pressure [systolic and mean arterial blood pressure (MABP)], pulse rate, QRS complex changes at 12 hours after admission. QRS complex had much more width in these patients in comparison with others. There was no correlation between loss of consciousness and diastolic blood pressure, QT interval and PR interval on admisson and 12 hours and 24 hours later.Conclusion: Regarding the founded relation between level of consciousness and changes at 12 hours after admission, evaluation of patients about vital sign and ECG monitoring, specialy in lower level of consciousness, should be considered; it will lead to prevent unexpected complication, mortality and to reduce the length of hospitalisation. Background: Due to significant effects of carbamazepine toxicity on the cardiovascular system and the present contraversy about the frequency of cardiovascular manifestations in such patients, this study was designed to evaluate this issue more throughly.Methods: In a cross-sectional study, patients with carbamazepine poisoning referred to Nour Hospital, Isfahan, were recruited using convinience sampling method. ECG parameters (QRS complex, QT interval, and PR interval), pulse rate, and blood pressure changes, as well as consciousness alterations, were measured in patients on admission and 12 and 24 hours later.Finding: Among 77 patients 49 (63.6%) were women. There was no significant relationship between QT interval and QRS complex changes and pulse rate alteration and carbamazepine toxicity; but there was meaningful association between pulse rate, blood pressure (systolic and diastolic), and PR interval changes. Furtheremore, there was significant decreasing relationship between loss of consciousness (coma) and blood pressure [systolic and mean arterial blood pressure (MABP)], pulse rate, QRS complex changes at 12 hours after admission. QRS complex had much more width in these patients in comparison with others. There was no correlation between loss of consciousness and diastolic blood pressure, QT interval and PR interval on admisson and 12 hours and 24 hours later.Conclusion: Regarding the founded relation between level of consciousness and changes at 12 hours after admission, evaluation of patients about vital sign and ECG monitoring, specialy in lower level of consciousness, should be considered; it will lead to prevent unexpected complication, mortality and to reduce the length of hospitalisation. https://jims.mui.ac.ir/article_13242_3a78f1864ab77dbd239fbe33cae90bbb.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121The Value of Intrarenal Resistive Index in Different Stages of Diabetic NephropathyThe Value of Intrarenal Resistive Index in Different Stages of Diabetic Nephropathy1168117213243FAMaryamMoradiAssistant Professor, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0002-5255-588XMehriSirousAssociate Professor, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.HabibEsmaeiliResident, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Seyed Mohammad HosseinMohseniResident, Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20110319Background: The renal resistive index (RI), measured using doppler ultrasound, reflects intrarenal vascular resistance. We evaluated the relationship between RI with nephropathy in patients with diabetic mellitus.Methods: This study was done in Al-Zahra hospital in Isfahan. Fifty seven patients with diabetes mellitus in 3 groups (stage I, II and III of nephropathy) were compared with 19 patients in control group. The patients with renal artery stenosis or severe renal failure were excluded from the study.Finding: The mean age was 56.42 ± 10.45 years in patients. RI was 59.8 ± 2.2 percent in patients in stage I of nephropathy and in stage II and III of nephropathy it was 61.4 ± 5.8 and 82.4 ± 11.1 percent respectively. RI in control group was 63.1±5.6 percent. The RI in diabetic patients in stage III was significantly higher than other groups (P < 0.001).Conclusion: The results suggest that increased RI of the renal arteries can be more useful in patients in stage III of diabetic nephropathy. Background: The renal resistive index (RI), measured using doppler ultrasound, reflects intrarenal vascular resistance. We evaluated the relationship between RI with nephropathy in patients with diabetic mellitus.Methods: This study was done in Al-Zahra hospital in Isfahan. Fifty seven patients with diabetes mellitus in 3 groups (stage I, II and III of nephropathy) were compared with 19 patients in control group. The patients with renal artery stenosis or severe renal failure were excluded from the study.Finding: The mean age was 56.42 ± 10.45 years in patients. RI was 59.8 ± 2.2 percent in patients in stage I of nephropathy and in stage II and III of nephropathy it was 61.4 ± 5.8 and 82.4 ± 11.1 percent respectively. RI in control group was 63.1±5.6 percent. The RI in diabetic patients in stage III was significantly higher than other groups (P < 0.001).Conclusion: The results suggest that increased RI of the renal arteries can be more useful in patients in stage III of diabetic nephropathy. https://jims.mui.ac.ir/article_13243_1de77f62112ca5add5de20c6074f34b6.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121The Outcomes of Chest Trauma; A 10 Years SurveyThe Outcomes of Chest Trauma; A 10 Years Survey1173117913244FASayed EbrahimNoorianAssistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medial Sciences, Isfahan, IranMohsenMahmoodiehAssistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medial Sciences, Isfahan, IranAmirDehghaniMedical Student, School of Medicine, Isfahan University of Medial Sciences, Isfahan, IranJournal Article20110319Background:Trauma is the most common cause of death for people younger than 45 years. Chest injury is severely life-threatening and is associated with mortality and significant disability. Methods: This cross-sectional study was done on 252 treated patients with penetrating chest injuries during ten years period in Alzahra hospital in Isfahan, Iran. Data including age, sex, mechanism of trauma, complications of trauma, trauma associated, the need for surgical treatment, traumatic treatment onset, and mortality were collected from patients’ records. Collected data were analyzed with the SPSS statistical software. Finding: The mean age of studied patients was 35.02 ± 10.73 years. 89.2% of patients were men and 10.8% of them were women. The most common mechanism of trauma was the the knife injury. 109 patients needed surgery in the first 24 hours after trauma. Mortality rate in the studied population was 8.7%. Most deaths (6.8 percent) were observed in injured patients since that their treatment was started after 90 minutes of trauma. The average time of treatment was significantly different in two groups of living and dead patients.Conclusion:According to the results of this study, social and cultural activities seem to be necessary to help youth to ban carrying knives. In the other hand, control of the roads and encouraging people to observe rules can reduce the amount and severity of injuries.Background:Trauma is the most common cause of death for people younger than 45 years. Chest injury is severely life-threatening and is associated with mortality and significant disability. Methods: This cross-sectional study was done on 252 treated patients with penetrating chest injuries during ten years period in Alzahra hospital in Isfahan, Iran. Data including age, sex, mechanism of trauma, complications of trauma, trauma associated, the need for surgical treatment, traumatic treatment onset, and mortality were collected from patients’ records. Collected data were analyzed with the SPSS statistical software. Finding: The mean age of studied patients was 35.02 ± 10.73 years. 89.2% of patients were men and 10.8% of them were women. The most common mechanism of trauma was the the knife injury. 109 patients needed surgery in the first 24 hours after trauma. Mortality rate in the studied population was 8.7%. Most deaths (6.8 percent) were observed in injured patients since that their treatment was started after 90 minutes of trauma. The average time of treatment was significantly different in two groups of living and dead patients.Conclusion:According to the results of this study, social and cultural activities seem to be necessary to help youth to ban carrying knives. In the other hand, control of the roads and encouraging people to observe rules can reduce the amount and severity of injuries.https://jims.mui.ac.ir/article_13244_08823e44200e4d4e71674e8104eff7dd.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121Evaluation and Long-Term Follow-Up of Congenital Lobar EmphysemaEvaluation and Long-Term Follow-Up of Congenital Lobar Emphysema1180118613245FAMasoudNazemAssistant Professor, Department of Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0002-7347-435XMehrdadReisiMedical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20110319Background: Congenital lobar emphysema (CLE) is a malformation of the lung characteristic over distension of the affected lobe. Although surgical removal of the affected lobe is the most commonly accepted form of treatment, detection of mild or even asymptomatic cases is usually followed by conservative method. Infants and children have an excellent response to lobectomy. Mortality is rare in a modern pediatric surgical environment. The risks of lung resection include morbidity related to empyema, infection. The diagnosis is best established by CXR.Methods: This study was performed in Alzahra haspital and we studied all 30 patients with CLE. Data was collected using reliable and valid questionnaire.Finding: According to results of this study, 77% boys and 66% girls had Abnormal bronchial cartilage support pathology. Diagnosis was obtained by CXR. The mean age at diagnosis in girls was 4.7± 1.2 months and in the boys was 7.2 ± 2.3 months. Lobectomy were done for 26(86.7%) patients, 4 patients were followed conservatively. Twenty four (92.3%) patients had only one affected lobe. In the long-term follow up, 5% of boys and 30% of girls had cyanosis. 20% in both girls and boys had pneumothorax after lobectomy but 5% and 20% in boys and girls had infection after lobectomy respectively. None of the patients had tracheobronchial fistula and 20% girls had early fatigue. Three of 4 deaths in this study belonged to the male sex.Conclusion: In this study CLE was with 2:1 male predominance. The age that symptoms developed was lower in girls than boys. The prognosis of CLE was better in boys than girls. Height growth in boys was more than girls. Early fatigue was more common in girls. In our study most of the deaths were in boys. Background: Congenital lobar emphysema (CLE) is a malformation of the lung characteristic over distension of the affected lobe. Although surgical removal of the affected lobe is the most commonly accepted form of treatment, detection of mild or even asymptomatic cases is usually followed by conservative method. Infants and children have an excellent response to lobectomy. Mortality is rare in a modern pediatric surgical environment. The risks of lung resection include morbidity related to empyema, infection. The diagnosis is best established by CXR.Methods: This study was performed in Alzahra haspital and we studied all 30 patients with CLE. Data was collected using reliable and valid questionnaire.Finding: According to results of this study, 77% boys and 66% girls had Abnormal bronchial cartilage support pathology. Diagnosis was obtained by CXR. The mean age at diagnosis in girls was 4.7± 1.2 months and in the boys was 7.2 ± 2.3 months. Lobectomy were done for 26(86.7%) patients, 4 patients were followed conservatively. Twenty four (92.3%) patients had only one affected lobe. In the long-term follow up, 5% of boys and 30% of girls had cyanosis. 20% in both girls and boys had pneumothorax after lobectomy but 5% and 20% in boys and girls had infection after lobectomy respectively. None of the patients had tracheobronchial fistula and 20% girls had early fatigue. Three of 4 deaths in this study belonged to the male sex.Conclusion: In this study CLE was with 2:1 male predominance. The age that symptoms developed was lower in girls than boys. The prognosis of CLE was better in boys than girls. Height growth in boys was more than girls. Early fatigue was more common in girls. In our study most of the deaths were in boys. https://jims.mui.ac.ir/article_13245_d68229f521316a03b517e42128c87060.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121Clinical Signs, Hospitalization Duration and Outcome of Tramadol IntoxicationClinical Signs, Hospitalization Duration and Outcome of Tramadol Intoxication1187119313246FANastaranEizadiAssociate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Ali MohammadSabzghabaeeAssociate Professor of Pharmacotherapy, Isfahan Clinical Toxicology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran .AzadehSafdariMedical Student, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.AhmadYaraghiAssociate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.0000-0001-8532-9005Journal Article20110319Background: Regarding increasing tramadol toxicity in recent years due to usage of tramadol as a drug for suppression of withdrawal symptoms and high availability of this drug, we did a survey on the frequency of tramadol intoxication symptoms, duration of admission, therapeutic measurements, tramadol dosage, and prognosis of the patients.Methods: We conducted a cross sectional study, in which information of every patient with tramadol toxicity admitted in Noor hospital ward of toxicology (Isfahan, Iran) were gathered and analyzed.Finding: From 184 cases, 141 (76.6%) were men. The mean age of the patients was 24 ± 7 years. Forty percent of patient had positive history of substance abuse. Eighty four cases (45.6%) were with co-ingestion. Thirty four percent of patients had chronic ingestion of tramadol. The most common chief complaint was central nervous system (CNS) depression (57%) followed by seizure (25%), bradypnea (18%), tachycardia (25%), and hypertension (7%). Active charcol (89%), gastric lavage (81%), naloxane (25%), anti convulsants (11%), and intubation and ventilation (5%) were done as therapeutic acts. The most common complication in patients was aspiration pneumonia. Two (1.1%) patients died. There were significant relationships between tramadol dose and seizure (P = 0.036), ataxia (P = 0.002), and outcome (P < 0.001).Conclusion: Tramadol overdose frequently cause CNS depression, respiratory depression, tachycardia, hypertension, and seizure; these symptoms could be from both effects of tramadol either on mu receptor or inhibition of monoamine reuptake. Background: Regarding increasing tramadol toxicity in recent years due to usage of tramadol as a drug for suppression of withdrawal symptoms and high availability of this drug, we did a survey on the frequency of tramadol intoxication symptoms, duration of admission, therapeutic measurements, tramadol dosage, and prognosis of the patients.Methods: We conducted a cross sectional study, in which information of every patient with tramadol toxicity admitted in Noor hospital ward of toxicology (Isfahan, Iran) were gathered and analyzed.Finding: From 184 cases, 141 (76.6%) were men. The mean age of the patients was 24 ± 7 years. Forty percent of patient had positive history of substance abuse. Eighty four cases (45.6%) were with co-ingestion. Thirty four percent of patients had chronic ingestion of tramadol. The most common chief complaint was central nervous system (CNS) depression (57%) followed by seizure (25%), bradypnea (18%), tachycardia (25%), and hypertension (7%). Active charcol (89%), gastric lavage (81%), naloxane (25%), anti convulsants (11%), and intubation and ventilation (5%) were done as therapeutic acts. The most common complication in patients was aspiration pneumonia. Two (1.1%) patients died. There were significant relationships between tramadol dose and seizure (P = 0.036), ataxia (P = 0.002), and outcome (P < 0.001).Conclusion: Tramadol overdose frequently cause CNS depression, respiratory depression, tachycardia, hypertension, and seizure; these symptoms could be from both effects of tramadol either on mu receptor or inhibition of monoamine reuptake. https://jims.mui.ac.ir/article_13246_51cece00aed19468f18042ad0606a3d3.pdfIsfahan University of Medical SciencesJournal of Isfahan Medical School1027-75952811720110121The Relationship between Hemoglobin Level before Acute Normovolemic Hemodilution and Nadir Level of Hemoglobin during Cardiopulmonary By-pass in Elective Coronary Artery Bypass Graft SurgeryThe Relationship between Hemoglobin Level before Acute Normovolemic Hemodilution and Nadir Level of Hemoglobin during Cardiopulmonary By-pass in Elective Coronary Artery Bypass Graft Surgery1194120413247FAMojtabaMansouriAssistant Professor, Department of Anesthesiology, School of Medicine, Isfahan UniversitySasanHabib EkhiariStudent of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.Journal Article20110319Background: Current data suggests that basal hemoglobin of 12 mg/dl is suitable for practicing Acute Normovolemic Hemodilution (ANH), during operations not necessitating cardiopulmonary bypass. This level seems to be too low when using CPB, complicating this procedure.Methods: To study the relationship between Hb level before ANH and baseline level of hemoglobin, 581 patients were investigated during cardiopulmonary bypass in elective coronary artery bypass graft (CABG) surgery. Convenient sampling method was used. Repeated measurements of hemoglobin level were done during the operation.Finding: The mean of baseline hemoglobin, first hemoglobin after going on-pomp, nadir hemoglobin during pomp, and hemoglobin during pomp for patients underwent ANH was 15.18, 8.38, 7.8 and 8.2 mg/dl respectively and 13.1, 7.7, 7.2, and 7.6 mg/dl for patients who did not undergo ANH. There was significant correlation between basal and first Hb hemoglobin going on-pomp, nadir hemoglobin during pomp and mean hemoglobin during pomp in both ANH and no-ANH groups (P < 0.001). There was significant difference between results of current formula to predetermine nadir hemoglobin, and our actual nadir hemoglobin obtained from patients. Minimum level of suitable basal hemoglobin for practicing ANH (450 ml) during on-pomp CABG, was calculated to be 14.55 mg/dl (sensitivity: 77%, specificity: 70%, and AUC: 0.805) and 12.95 mg/dl (sensitivity: 71%, specificity: 64%, and AUC: 0.686) for on-pomp CABG without ANH.Conclusion: Basal hemoglobin for practicing ANH during on-pomp surgery, somehow, depends on threshold hemoglobin for blood transfusion and acceptance of advantages and disadvantages of ANH and its complications by physician and patient.Background: Current data suggests that basal hemoglobin of 12 mg/dl is suitable for practicing Acute Normovolemic Hemodilution (ANH), during operations not necessitating cardiopulmonary bypass. This level seems to be too low when using CPB, complicating this procedure.Methods: To study the relationship between Hb level before ANH and baseline level of hemoglobin, 581 patients were investigated during cardiopulmonary bypass in elective coronary artery bypass graft (CABG) surgery. Convenient sampling method was used. Repeated measurements of hemoglobin level were done during the operation.Finding: The mean of baseline hemoglobin, first hemoglobin after going on-pomp, nadir hemoglobin during pomp, and hemoglobin during pomp for patients underwent ANH was 15.18, 8.38, 7.8 and 8.2 mg/dl respectively and 13.1, 7.7, 7.2, and 7.6 mg/dl for patients who did not undergo ANH. There was significant correlation between basal and first Hb hemoglobin going on-pomp, nadir hemoglobin during pomp and mean hemoglobin during pomp in both ANH and no-ANH groups (P < 0.001). There was significant difference between results of current formula to predetermine nadir hemoglobin, and our actual nadir hemoglobin obtained from patients. Minimum level of suitable basal hemoglobin for practicing ANH (450 ml) during on-pomp CABG, was calculated to be 14.55 mg/dl (sensitivity: 77%, specificity: 70%, and AUC: 0.805) and 12.95 mg/dl (sensitivity: 71%, specificity: 64%, and AUC: 0.686) for on-pomp CABG without ANH.Conclusion: Basal hemoglobin for practicing ANH during on-pomp surgery, somehow, depends on threshold hemoglobin for blood transfusion and acceptance of advantages and disadvantages of ANH and its complications by physician and patient.https://jims.mui.ac.ir/article_13247_eb61c2b1b1bf5d25c86da9fceef54538.pdf