Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 30 198 2012 08 22 Comparing the Quality of Pediatric Care by Routine Protocols and Integrated Management of Childhood Illness Comparing the Quality of Pediatric Care by Routine Protocols and Integrated Management of Childhood Illness 13846 FA Sayed Reza Eshaghi Assistant Professor, Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Behzad Shams Associate Professor, Department of Pediatrics, Child Growth and Development Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0003-4320-388X Habibeh Ahmadi Pour 3 Assistant Professor, Department of Community Medicine, School of Medicine, Kerman University of Medical Sciences, Kerman AND Resident, Department of Community Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0001-5880-451X Neda Zamani Assistant Professor, Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2011 06 19 Background: Children account for 30-70% of all patients seen in outpatient clinics. Studies have shown integrated methods to improve quality of outpatient care in children. The present study aimed to compare quality of care between routine and integrated methods in pediatric outpatient setting. Methods: This double-blinded prospective study was carried out in two pediatric clinics of Amin Hospital (Isfahan, Iran). Non-probability convenience sampling was used to select 100 children. Performance of medical interns in visiting these children was assessed by an observer through a checklist. Then, students in clinic A were trained in Integrated Management of Childhood Illness (IMCI) algorithms. The performance of the two groups in visiting 100 children was reevaluated at the end of the period again. The mean of their scores and frequency of each item of the checklist was calculated and compared between the two groups. Findings: The mean scores of performance of the two groups had no significant difference. Only the frequency of few items of the checklist was significantly different between the two groups. Conclusion: We found no significant difference between the two groups. It may be due to short training period, interest in textbooks, lack of knowledge about efficacy of IMCI algorithms in the future work, and not having adequate time for practicing. Another reason may be low power of our study. Keywords: Integrated management of childhood illness, Quality of health care, Preschool children Background: Children account for 30-70% of all patients seen in outpatient clinics. Studies have shown integrated methods to improve quality of outpatient care in children. The present study aimed to compare quality of care between routine and integrated methods in pediatric outpatient setting. Methods: This double-blinded prospective study was carried out in two pediatric clinics of Amin Hospital (Isfahan, Iran). Non-probability convenience sampling was used to select 100 children. Performance of medical interns in visiting these children was assessed by an observer through a checklist. Then, students in clinic A were trained in Integrated Management of Childhood Illness (IMCI) algorithms. The performance of the two groups in visiting 100 children was reevaluated at the end of the period again. The mean of their scores and frequency of each item of the checklist was calculated and compared between the two groups. Findings: The mean scores of performance of the two groups had no significant difference. Only the frequency of few items of the checklist was significantly different between the two groups. Conclusion: We found no significant difference between the two groups. It may be due to short training period, interest in textbooks, lack of knowledge about efficacy of IMCI algorithms in the future work, and not having adequate time for practicing. Another reason may be low power of our study. Keywords: Integrated management of childhood illness, Quality of health care, Preschool children https://jims.mui.ac.ir/article_13846_9c25dc28b94e5226f1983330dc421cec.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 30 198 2012 08 22 Development and Implementation of the Convolution Method for Photon Dose Calculation in Radiation Therapy Development and Implementation of the Convolution Method for Photon Dose Calculation in Radiation Therapy 13847 FA Keyvan Jabbari Assistant Professor, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Mohamad Bagher Tavakoli Professor, Department of Medical Physics and Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Sayed Mojtaba Hosseini MSc Student, Department of Medical Physics and Engineering, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2012 04 12 Background: One of the most widely used methods in cancer treatment is radiation therapy. In radiation therapy, the goal is to deliver maximum dose to the cancerous tissue and the least amount to adjacent normal tissue. Therefore, it is important to calculate radiation doses received by different points of body. These calculations are performed by treatment planning systems. The aim of this project was to develop and implement the convolution algorithm in the form of a code. The accuracy of doses calculated by the code was then compared with experimental values. Methods: Full scatter convolution method was used in this project. Considering a phantom with dimensions of 11.5 × 11.5 × 11.25 cm3 and field sizes of 3 × 3, 5 × 5, and 10 × 10 cm2 on its surface, the code was written by MATLAB program. Incident photon energy was considered as 6 MeV. Finally, percentage depth dose values were compared with experimental values. Findings: The mean percent difference values were 1.527%, 1.51%, and 3.00% for field sizes of 3 × 3, 5 × 5, and 10×10 cm2, respectively. Conclusion: Percentage differences between the doses calculated by the code and experimental values were less than 5% for all three field sizes. According to the recommendations of Task Group 53 of the Radiation Therapy Committee of the American Association of Physicists in Medicine, the values were in the acceptable range. Keywords: Radiotherapy planning, Radiation therapy, Photons, Convolution algorithm Background: One of the most widely used methods in cancer treatment is radiation therapy. In radiation therapy, the goal is to deliver maximum dose to the cancerous tissue and the least amount to adjacent normal tissue. Therefore, it is important to calculate radiation doses received by different points of body. These calculations are performed by treatment planning systems. The aim of this project was to develop and implement the convolution algorithm in the form of a code. The accuracy of doses calculated by the code was then compared with experimental values. Methods: Full scatter convolution method was used in this project. Considering a phantom with dimensions of 11.5 × 11.5 × 11.25 cm3 and field sizes of 3 × 3, 5 × 5, and 10 × 10 cm2 on its surface, the code was written by MATLAB program. Incident photon energy was considered as 6 MeV. Finally, percentage depth dose values were compared with experimental values. Findings: The mean percent difference values were 1.527%, 1.51%, and 3.00% for field sizes of 3 × 3, 5 × 5, and 10×10 cm2, respectively. Conclusion: Percentage differences between the doses calculated by the code and experimental values were less than 5% for all three field sizes. According to the recommendations of Task Group 53 of the Radiation Therapy Committee of the American Association of Physicists in Medicine, the values were in the acceptable range. Keywords: Radiotherapy planning, Radiation therapy, Photons, Convolution algorithm https://jims.mui.ac.ir/article_13847_b2f1384b8feb04d2de9a85124dc64613.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 30 198 2012 08 22 Comparison of Severity of Osteoporosis in Women with Primary Hypothyroidism and Healthy Women Comparison of Severity of Osteoporosis in Women with Primary Hypothyroidism and Healthy Women 13848 FA Farah Esmaili Resident, Department of Internal Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran Amir Hossein Salari Assistant Professor, Department of Rheumatology, School of Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-7542-7426 Mansoor Karimifar Associate Professor, Department of Rheumatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0001-5946-8140 Ali Kachuei Associate Professor, Department of Endocrinology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Ziba Farajzadegan Associate Professor, Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-8811-6678 Neda Nazemzadeh Resident, Department of Internal Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran Mansoor Salesi Associate Professor, Department of Rheumatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0001-7108-6188 Hadi Karimzadeh Associate Professor, Department of Rheumatology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0001-8303-4203 Journal Article 2012 04 15 Background: Studies on bone mineral density (BMD) disorders associated with hypothyroidism are inadequate. The effects of thyroid hormone therapy on BMD in primary hypothyroidism have been different. This study aimed to determine the severity of osteoporosis in patients with hypothyroidism compared with healthy women. Methods: This descriptive, analytical study was conducted on women who were referred to Alzahra Hospital (Isfahan, Iran) during 2011. A total number of 150 subjects were divided into 3 groups of 50. Group A had been recently diagnosed with primary hypothyroidism. Group B included patients with primary hypothyroidism who had at least received levothyroxine for 2 years. Group C consisted of healthy individuals who were used as controls. After obtaining consents, bone densitometry was performed. Data was collected using a checklist including age, weight, height, body mass index (BMI), age at menopause , duration of levothyroxine administration (if used), severity of osteoporosis based on densitometry, and serum thyroid stimulating hormone (TSH). Data was analyzed by regression analysis, Kruskal-Wallis and Mann-Whitney tests, and analysis of variance (ANOVA). P values less than 0.0.5 were considered significant. Findings: The mean age, TSH levels, and T scores of lumbar vertebrae (L2-L4) in group B were significantly lower than the other two groups (P < 0.001, P < 0.05, and P < 0.05, respectively). There was no relation between osteoporosis and TSH levels. However, after adjustment for TSH, frequency of osteoporosis was significantly higher in group B (P < 0.05). Conclusion: Although patients newly diagnosed with hypothyroidism (group A) had significantly higher TSH levels, there was no significant difference between them and controls in bone density of lumbar spine and femoral neck. Since patients who had used levothyroxine for at least 2 years had lower TSH and bone density compared to the control group, treatment of low bone mass in patients with hypothyroidism is necessary. Keywords: Osteoporosis, Women, Primary hypothyroidism Background: Studies on bone mineral density (BMD) disorders associated with hypothyroidism are inadequate. The effects of thyroid hormone therapy on BMD in primary hypothyroidism have been different. This study aimed to determine the severity of osteoporosis in patients with hypothyroidism compared with healthy women. Methods: This descriptive, analytical study was conducted on women who were referred to Alzahra Hospital (Isfahan, Iran) during 2011. A total number of 150 subjects were divided into 3 groups of 50. Group A had been recently diagnosed with primary hypothyroidism. Group B included patients with primary hypothyroidism who had at least received levothyroxine for 2 years. Group C consisted of healthy individuals who were used as controls. After obtaining consents, bone densitometry was performed. Data was collected using a checklist including age, weight, height, body mass index (BMI), age at menopause , duration of levothyroxine administration (if used), severity of osteoporosis based on densitometry, and serum thyroid stimulating hormone (TSH). Data was analyzed by regression analysis, Kruskal-Wallis and Mann-Whitney tests, and analysis of variance (ANOVA). P values less than 0.0.5 were considered significant. Findings: The mean age, TSH levels, and T scores of lumbar vertebrae (L2-L4) in group B were significantly lower than the other two groups (P < 0.001, P < 0.05, and P < 0.05, respectively). There was no relation between osteoporosis and TSH levels. However, after adjustment for TSH, frequency of osteoporosis was significantly higher in group B (P < 0.05). Conclusion: Although patients newly diagnosed with hypothyroidism (group A) had significantly higher TSH levels, there was no significant difference between them and controls in bone density of lumbar spine and femoral neck. Since patients who had used levothyroxine for at least 2 years had lower TSH and bone density compared to the control group, treatment of low bone mass in patients with hypothyroidism is necessary. Keywords: Osteoporosis, Women, Primary hypothyroidism https://jims.mui.ac.ir/article_13848_f1e1fd9e97f59379ed79bdf258d55042.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 30 198 2012 08 22 Assessing Cell Cycle of Human T Lymphocytes Activated by Anti-CD3 and Anti-CD28 Monoclonal Antibodies Using Flow Cytometry in Vitro Assessing Cell Cycle of Human T Lymphocytes Activated by Anti-CD3 and Anti-CD28 Monoclonal Antibodies Using Flow Cytometry in Vitro 13849 FA Elahe Noorijavid Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Marjan Gharagozloo Assistant Professor, Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Abbas Rezaei Professor, Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2012 06 19 Background: T lymphocyte proliferation is central for adaptive immune response. Proliferation of T lymphocytes is initiated by the engagement of T cell receptor (TCR) and costimulatory receptors (CD28) which culminate with cell cycle entry and clonal expansion. This study aimed to use flow cytometry test to assay cell cycle of human T lymphocytes activated by anti-CD3 and anti-CD28 monoclonal antibodies in different incubation times in vitro. Methods: After obtaining 10 cc heparinized blood samples from normal volunteer donors, peripheral blood mononuclear cells (PBMCs) were separated by ficoll density-gradient centrifugation. The cells were then activated with anti human CD3 (OKT3) at 5 μg/ml and soluble anti human CD28 monoclonal antibody at 2 μg/mL in coated 24-well plates. Incubation was conducted at 37°C for 2 hours or at 4°C overnight. Finally, cell cycle analysis was performed using flow cytometry. Findings: Cell cycle histogram of activated T lymphocytes showed all the cells in G1 phase 24 and 48 hours after activation. However, activated cells entered into S and G2M phases 72 and 96 hours after activation. Conclusion: The degree and the length of TCR and CD28 occupancy are both critical for T cells to leave the G0 stage and enter different phases of cell cycle. Activation of Activated T cells need more than 24 and 48 hours to progress out of G1 phase. However, the cells could progress to S and G2 phases 72 and 96 hours after activation. Keywords: Cell cycle, T lymphocytes, Flow cytometry   Background: T lymphocyte proliferation is central for adaptive immune response. Proliferation of T lymphocytes is initiated by the engagement of T cell receptor (TCR) and costimulatory receptors (CD28) which culminate with cell cycle entry and clonal expansion. This study aimed to use flow cytometry test to assay cell cycle of human T lymphocytes activated by anti-CD3 and anti-CD28 monoclonal antibodies in different incubation times in vitro. Methods: After obtaining 10 cc heparinized blood samples from normal volunteer donors, peripheral blood mononuclear cells (PBMCs) were separated by ficoll density-gradient centrifugation. The cells were then activated with anti human CD3 (OKT3) at 5 μg/ml and soluble anti human CD28 monoclonal antibody at 2 μg/mL in coated 24-well plates. Incubation was conducted at 37°C for 2 hours or at 4°C overnight. Finally, cell cycle analysis was performed using flow cytometry. Findings: Cell cycle histogram of activated T lymphocytes showed all the cells in G1 phase 24 and 48 hours after activation. However, activated cells entered into S and G2M phases 72 and 96 hours after activation. Conclusion: The degree and the length of TCR and CD28 occupancy are both critical for T cells to leave the G0 stage and enter different phases of cell cycle. Activation of Activated T cells need more than 24 and 48 hours to progress out of G1 phase. However, the cells could progress to S and G2 phases 72 and 96 hours after activation. Keywords: Cell cycle, T lymphocytes, Flow cytometry   https://jims.mui.ac.ir/article_13849_9a5859b8f76280c97c0c185a19d17014.pdf

Isfahan University of Medical Sciences Journal of Isfahan Medical School 1027-7595 30 198 2012 08 22 Effects of Adding Low-Dose Ketamine to Remifentanil-Midazolam Infusion under Topical Anesthesia on Pain Relief after Nasal Bone Fracture Effects of Adding Low-Dose Ketamine to Remifentanil-Midazolam Infusion under Topical Anesthesia on Pain Relief after Nasal Bone Fracture 13850 FA Mojtaba Rahimi Assistant Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Azim Honarmand Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-2373-9241 Fatemeh Naderi Student of Medicine, School of Medicine AND Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran Mohammad Reza Safavi Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran 0000-0002-8975-7661 Morteza Heidari Associate Professor, Department of Anesthesiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran Journal Article 2012 06 23 Background: Pain relief after nasal bone fracture surgery is unsatisfactory. The present study aimed to evaluate the effects of adding low-dose ketamine to remifentanil-midazolam infusion under topical anesthesia on pain relief after nasal bone fracture. Methods: In a controlled study, 68 nasal bone fracture surgery candidates were allocated to two groups receive infusion of 2 µg/kg remifentanil and 0.05 mg/kg midazolam plus 0.5 mg/kg of either ketamine (ketamine group) or placebo (control group). Pain intensity was assessed using a visual analogue scale. Patient satisfaction and the amount of rescue analgesic used were recorded until 60 minutes after surgery. Repeated measures analysis of variance (ANOVA) was used to analyze the data. Findings: In the ketamine group, pain intensity 0, 15, 30, 45, and 60 minutes after operation was 3.5 ± 2.1, 1.2 ± 2.0, 1.8 ± 2.4, 1.3 ± 2.1, and 1.9 ± 2.2, respectively. The corresponding values in the control groups were 3.7 ± 2.2, 8.6 ± 2.0, 4.7 ± 1.2, 3.1 ± 1.2, and 3.7 ± 0.9. The difference between the two groups was statistically significant (P = 0.001). Moreover, patient satisfaction in the ketamine group was higher than the control group (P = 0.005). The dosage of rescue pethidine was significantly lower in the ketamine group compared to the control group (P = 0.045). Conclusion: This study showed that adding 0.5 mg/kg ketamine to 2 µg/kg remifentanil and 0.05 mg/kg midazolam improved postoperative pain relief. Keywords: Ketamine, Postoperative pain, Nasal bone fracture, Infusion, Topical anesthesia Background: Pain relief after nasal bone fracture surgery is unsatisfactory. The present study aimed to evaluate the effects of adding low-dose ketamine to remifentanil-midazolam infusion under topical anesthesia on pain relief after nasal bone fracture. Methods: In a controlled study, 68 nasal bone fracture surgery candidates were allocated to two groups receive infusion of 2 µg/kg remifentanil and 0.05 mg/kg midazolam plus 0.5 mg/kg of either ketamine (ketamine group) or placebo (control group). Pain intensity was assessed using a visual analogue scale. Patient satisfaction and the amount of rescue analgesic used were recorded until 60 minutes after surgery. Repeated measures analysis of variance (ANOVA) was used to analyze the data. Findings: In the ketamine group, pain intensity 0, 15, 30, 45, and 60 minutes after operation was 3.5 ± 2.1, 1.2 ± 2.0, 1.8 ± 2.4, 1.3 ± 2.1, and 1.9 ± 2.2, respectively. The corresponding values in the control groups were 3.7 ± 2.2, 8.6 ± 2.0, 4.7 ± 1.2, 3.1 ± 1.2, and 3.7 ± 0.9. The difference between the two groups was statistically significant (P = 0.001). Moreover, patient satisfaction in the ketamine group was higher than the control group (P = 0.005). The dosage of rescue pethidine was significantly lower in the ketamine group compared to the control group (P = 0.045). Conclusion: This study showed that adding 0.5 mg/kg ketamine to 2 µg/kg remifentanil and 0.05 mg/kg midazolam improved postoperative pain relief. Keywords: Ketamine, Postoperative pain, Nasal bone fracture, Infusion, Topical anesthesia https://jims.mui.ac.ir/article_13850_d3f010d6bc392b904f63ce5792891b71.pdf