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1.  Indoor Smoke Exposure and Risk of Anthracosis 
The association between indoor smoke exposure due to traditional baking (baking homemade bread) and anthracosis has rarely been investigated. The aim of the present study is to quantify such association among the Iranian population. A hospital based case-control study was carried out on 83 anthracotic cases and 155 controls (83 individuals with non-anthracotic pulmonary disorders from the pulmonary ward and 72 persons from the surgical ward without any known pulmonary disorders). The interview was performed using the “American Thoracic Society” questionnaire, comprising demographic information, occupational history, cigarette smoking, and indoor smoke exposure due to traditional baking. Multivariate analysis was performed by logistic regression. Comparison between cases and pulmonary ward controls showed that only the association between indoor smoke exposure due to traditional baking and anthracosis in women was statistically significant (OR: 4.30, 95% CI: 1.31 to 14.10). This was concluded after adjusting for other risk factors such as occupational exposure to dust, age, and education. When surgical ward controls were considered as control, after controlling for the significant risk factors, we found a significant relationship between indoor smoke exposure due to traditional baking and anthracosis (OR: 3.35, 95% CI: 1.49 to 7.55). Based on the findings from this study, it is concluded that there is an association between indoor smoke exposure and anthracosis. Women are significantly more susceptible to anthracosis than men are when exposed to smoke exposure.
PMCID: PMC4242993  PMID: 25429181
Anthracosis; Indoor air pollution; Iran
2.  Prevalence of diabetic peripheral neuropathy in Iran: a systematic review and meta-analysis 
Diabetic peripheral neuropathy (DPN) is an important microvascular complication of diabetes mellitus (DM). It is a major contributor to foot ulceration and lower limb amputation in persons with DM and have also a significant negative effect on patient's quality of life. This meta-analysis reviews prevalence of DPN among patients with type 1 and 2 DM in Iran. Using PubMed and NLM Gateway (for MEDLINE), Institute of Scientific Information (ISI), and SCOPUS as the main international electronic data sources, and Iranmedex, Irandoc, and Scientific Information Database (SID), as the main domestic databases with systematic search capability, we systematically searched surveys, papers, and reports on the prevalence of DPN (between January 1991 to February 2013). Heterogeneity of reported prevalence’s between studies was assessed by the Chi-square-based Q test and due to heterogeneity; overall prevalence of DPN was estimated using random-effect meta-analysis model. We found 304 records; from them a total of 21 studies comprising 5540 diabetic patients were included. The prevalence of diabetic neuropathy (reported) from 16% to 87%. In overall the prevalence of DPN estimated 53% (95% CI: 41-65) by using random-effect. This study show that the prevalence of DPN seems very high among the population with diabetes in Iran and more than half of the patients with DM has any type of diabetic neuropathy.
PMCID: PMC4215018  PMID: 25364702
Diabetic peripheral neuropathy; Diabetes mellitus; Systematic review; Meta-analysis
3.  Rotavirus Infection in Children with Acute Gastroenteritis in Iran: A Systematic Review and Meta-analysis 
The recent studies show that Rotavirus is important cause of the acute gastroenteritis. The aim of this review is to estimate the number of Rotavirus infection among Iranian children by performing a systematic review and estimating a pooled data.
We performed a systematic literature review in relevant databases including PUBMED, MEDLINE, OVID, SID, MAGIRAN, and IRANMEDEX. Search in databases was done in October 10, 2013. Meta-analysis was performed using the STATA statistical package version 11. We assessed heterogeneity by Q-test and used random model for pooling measures of proportion of Rotavirus infection among Iranian children with diarrhea (and 95% confidence intervals [CI]). Sub group analysis between in-patient and outpatient group were done and publication bias was assessed by Egger and Begg tests.
A total of 154 records were identified in our searching. There were 36 studies including a total of 15,368 children with diarrhea. Out of 15,368 children, 6,338 were positive for Rotavirus gastroenteritis. Overall pooled estimate of infection with Rotavirus among cases of gastroenteritis was 0.35 (95% CI, 0.28-0.41). Pooled estimates for hospitalized children and outpatient subgroups were 0.39 (95% CI, 0.30-0.48), and 0.31 (95% CI, 0.23-0.38), respectively.
This study supports the importance of Rotavirus in the Iranian population such as common cause of diarrhea among children. Therefore, decision to adopt immunization programs to prevent Rotavirus infection might be helpful in Iran.
PMCID: PMC4223939  PMID: 25400878
Acute gastroenteritis; children; and diarrhea; Rotavirus infection
4.  Quality of published Iranian medical education research studies: a systematic review 
Background: Research in medical education has been paid more attention than before; however the quality of research reporting has not been comprehensively appraised. To evaluate the methodological and reporting quality of Iranian published medical education articles.
Methods: Articles describing medical students, residents, fellows or program evaluation were included. Articles related to continuing medical education or faculty development, review articles and reports, and studies considering both medical and nonmedical students were excluded. We searched MEDLINE through PubMed in addition to major Iranian medical education search engines and databases including Scientific Information Database (SID) from March 2003 to March 2008. The Medical Education Research Quality Index (MERSQI) scale and the Consolidated Standards of Reporting Trials (CONSORT 2001) were used for experimental studies and the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) was utilized for observational studies.
Results: Ninety five articles were found to be related to the medical education research in Iran including 16 (16.8%) experimental studies. Total MERSQI scores ranged between 3.82 and 13.09 with the mean of 8.39 points. Mean domain scores were highest for data analysis (1.85) and lowest for validity (0.61). The most frequently reported item was background (96%) and the least reported was the study limitations (16%).
Conclusion: The quality of published medical education research in Iran seems to be suboptimal.
PMCID: PMC4219908  PMID: 25405144
Systematic review; Medical education; Iran
5.  Assessing validity and reliability of Dundee ready educational environment measure (DREEM) in Iran 
Background: If an institute is looking for improvement of its learning environment, a reliable and valid assessment tool is needed for measurement of the educational environment .The Dundee Ready Educational Environment Measure (DREEM) has been used in various studies to evaluate the educational environment. However, psychometric evaluations of the instrument seem necessary, for all known versions of the instrument. The aim of this study was to investigate the reliability and validity of Persian version of the DREEM in the major clinical wards in teaching hospitals affiliated to Iran University of Medical Sciences.
Methods: This descriptive - analytical study, involved medical students (clinical stagers and interns) in 4 major clinical wards. In this study, DREEM questionnaire was reviewed in content, face validity and construct validity through confirmatory factor analysis. The reliability was calculated according to test - retest and the internal consistency was measured using Cronbach's alpha coefficient.
Results: A total number of 267 questionnaires were completed by medical stagers (60%) and interns (40%) including 181 females and 82 males. The mean age of stagers and interns were 23.60 ± 1.27 and 25.45 ± 1.22 years, respectively. The total mean of the questionnaire was calculated as 96.15 (93.5375, 98.7547) out of 176, with 95% confidence interval. The face validity of the questionnaire was confirmed. The mean of content validity ratio (CVR) was calculated as 0.35, and 6 questions were omitted in this step. The content validity index (CVI) was 0.39. The reliability coefficient mean was 0.71. In confirmatory factor analysis five factors were confirmed that changed the orientation of some questions. The Cronbach's alpha coefficient of the whole questionnaire was obtained as 0.914.
Conclusion: The modified and validates DREEM questionnaire in Persian language with 44 items and appropriate psychometric attributes is capable of being used in assessment of clinical education environments in Iran.
PMCID: PMC4219890  PMID: 25405126
Validity; Reliability; DREEM; Educational environment
6.  Seasonal pattern in admissions and mortality from acute myocardial infarction in elderly patients in Isfahan, Iran 
ARYA Atherosclerosis  2014;10(1):46-54.
Seasonal variation in admissions and mortality due to acute myocardial infarction has been observed in different countries. Since there are scarce reports about this variation in Iran, this study was carried out to determine the existence of seasonal rhythms in hospital admissions for acute myocardial infarction, and in mortality due to acute myocardial infarction (AMI) in elderly patients in Isfahan city.
This prospective hospital-based study included a total of 3990 consecutive patients with acute myocardial infarction admitted to 13 hospitals from January 2002 to December 2007. Seasonal variations were analyzed with the Kaplan-Meier table, log rank test, and Cox regression model.
There was a statistically significant relationship between the occurrence of heart disease based on season and type of acute myocardial infarction anatomical (P < 0.001). The relationship between the occurrence of death and season and type of AMI according to International Classification of Diseases code 10 (ICD) was also observed and it was statistically significant (P = 0.026). Hazard ratio for death from acute myocardial infarction were 0.96 [Confidence interval of 95% (95% CI) = 0.78-1.18], 0.9 (95%CI = 0.73-1.11), and 1.04 (95%CI = 0.85-1.26) during spring, summer, and winter, respectively.
There is seasonal variation in hospital admission and mortality due to AMI; however, after adjusting in the model only gender and age were significant predictor factors.
PMCID: PMC4063513  PMID: 24963314
Acute Myocardial Infarction; Season; Admission in Hospital; Mortality; Isfahan
7.  To Compare PubMed Clinical Queries and UpToDate in Teaching Information Mastery to Clinical Residents: A Crossover Randomized Controlled Trial 
PLoS ONE  2011;6(8):e23487.
To compare PubMed Clinical Queries and UpToDate regarding the amount and speed of information retrieval and users' satisfaction.
A cross-over randomized trial was conducted in February 2009 in Tehran University of Medical Sciences that included 44 year-one or two residents who participated in an information mastery workshop. A one-hour lecture on the principles of information mastery was organized followed by self learning slide shows before using each database. Subsequently, participants were randomly assigned to answer 2 clinical scenarios using either UpToDate or PubMed Clinical Queries then crossed to use the other database to answer 2 different clinical scenarios. The proportion of relevantly answered clinical scenarios, time to answer retrieval, and users' satisfaction were measured in each database.
Based on intention-to-treat analysis, participants retrieved the answer of 67 (76%) questions using UpToDate and 38 (43%) questions using PubMed Clinical Queries (P<0.001). The median time to answer retrieval was 17 min (95% CI: 16 to 18) using UpToDate compared to 29 min (95% CI: 26 to 32) using PubMed Clinical Queries (P<0.001). The satisfaction with the accuracy of retrieved answers, interaction with UpToDate and also overall satisfaction were higher among UpToDate users compared to PubMed Clinical Queries users (P<0.001).
For first time users, using UpToDate compared to Pubmed Clinical Querries can lead to not only a higher proportion of relevant answer retrieval within a shorter time, but also a higher users' satisfaction. So, addition of tutoring pre-appraised sources such as UpToDate to the information mastery curricula seems to be highly efficient.
PMCID: PMC3155565  PMID: 21858142
8.  A risk score development for diabetic retinopathy screening in Isfahan-Iran 
The purpose of this study was to develop a simple risk score as screening tool for retinopathy in type II diabetic patients.
A cross-sectional study was carried out recruiting 3734 patients with type II diabetes in an outpatient clinic in Isfahan Endocrinology and Metabolism Research Center (IEMRC), Iran. The logistic regression was used as a model to predict diabetic retinopathy. The cut-off value for the risk score was determined using the Receiver Operating Characteristic (ROC) curve procedure.
According to final models, being male, having lower body mass index (BMI), being older, longer duration of diabetes and higher HbA1c were correlated with increased risk of diabetic retinopathy. Area under the Curve (ROC) was 0.704 (95% CI: 0.685-0.723). A value ≥ 52.5 had the optimum sensitivity (60%) and specificity (69%) for determining diabetic retinopathy.
The results indicated that risk factors for retinopathy were sex, BMI, age, duration of diabetes and HbA1c levels. In conclusion, applying developed retinopathy risk score is a practical way to identify patients who are at high risk for developing diabetic retinopathy for an early treatment.
PMCID: PMC3129085  PMID: 21772868
Retinopathy risk score; sensitivity; specificity; receiver operating characteristic curve

Results 1-8 (8)