Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 4 3 2016 07 01 Clinical and Histopathology Features of Spitz Nevus: In 22 Cases 1 5 113505 10.30483/rijm.2016.117390 EN Mahtab Rahbar Associated Professor, Iran University of Medical Sciences, Tehran, IR Iran Ali Ghannadan Associated Professor, Tehran University of Medical Sciences, Tehran, IR Iran Kambiz Kamyab Associated Professor, Tehran University of Medical Sciences, Tehran, IR Iran Journal Article Background: Spitz Nevus is an infrequent acquired melanocytic nevus. There is still a challenge for dermatopathologists in dis- tinguishing spitz nevus from malignant melanoma particularly in adults since there is no immunohistochemistry or molecular markers which diﬀerentiate Spitz Nevus frommelanoma. Objectives: The aim of this study is to make clear what clinico-histopathological features of Spitz Nevus are in order to reduce malpractice due tomisdiagnosis. Methods: In the present study, a series of twenty two patients have been reviewed who were diagnosed with Spitz Nevous based on proved histopathology features between the years 2009 - 2013. The patients were evaluated for demographic parameters like age, sex, clinical diﬀerential diagnosis, cutaneous location of tumor, tumor diameter, subtype, symmetry,maturation, upper cleft- ing of melanocytic nest, shoulder phenomena, epidermal hyperplasia, type, kamino body,mitotic rate , inﬂammatory inﬁltration, pagetoid spread and regression. Results: In our study, 45% of patientswere younger than 10 years old. The average age of patientswas 1411.37. Male to female ratio was 1.44. The commonest location was head and neck. Spitz nevus was the ﬁrst clinical diﬀerential diagnosis in 20% of patients. The commonest variant type was conventional type and then polypoid and desmoplastic types. The mean size of nevi was 0.81 0.59mm. About 59% of nevi shows epithelioid cytologic features. Other histologic parameters fromthemost to the least frequency were symmetry (100%), maturation (100%), epidermal hyperplasia (77.3%), kamino body (68.2%), subtype (compound 68%), mitotic rate (63.6%), clefting (59%), inﬂammatory inﬁltration (54.5%), pagetoid spread (18.2%), shoulder (37.5%) and regression (9.1%). Conclusions: We tried to hifhlight some clinical and histopathological features which are distinguishing Spitz nevus from other melanocytic nevi evenmalignantmelanoma.

https://journal.razavihospital.ir/article_113505_7c0c44081119837b62e4ea508c6f00ba.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 4 3 2016 07 01 Echocardiographic Test and the Early Detection of Systolic Failure in Systemic Sclerosis Patients: Strain and Strain Rate Echocardiography 6 12 113506 10.30483/rijm.2016.117391 EN Zahra Rezai Yazdi Rheumatic Disease Research Center,Mashhad University of Medical Sciences,Mashhad, IR Iran Afsoon Fazlinezhad Cardiovascular Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Leila Bigdelu Cardiovascular Research Center, Mashhad University of Medical Sciences, Mashhad, IR Iran Fariba Alizadeh Sani Mashhad University of Medical Sciences,Mashhad, IR Iran Golsa Tabatabaei Yazdi Mashhad University of Medical Sciences,Mashhad, IR Iran Azra Izanloo Razavi Cancer Research Center, Razavi Hospital, Imam Reza International University, Mashhad, Iran Journal Article Background: Pulmonary arterial hypertension (PAH) is a leading cause of death in systemic sclerosis (SSc) patients. Early detection of systolic failure in SSc patients will facilitate early treatment and improve the survival rate of these patients. Objectives: In this study, besides studying the RV function in SSC patients, attempts have beenmade to ﬁnd a new possible nonin- vasive echocardiographic test for early diagnosis of systolic failure as a PAH complication. Methods: 30 patientswith at least a 2-year history of diﬀuse SSc conﬁrmed by an expert rheumatologistwere enrolled in this study. All the patients underwent transthoracic echocardiography by an echocardiologist. Fractional area change (FAC) of the right ven- tricle (RV), tricuspid annular plane systolic excursion (TAPSE), RV lateralwall strain and strain rate (Base,Mid, Apex), RV-EDD and RV pressure with respect to inferior vena cava (IVC) diameter as well as Left Ventricle’s Ejection Fraction (LVEF) were evaluated. Results: The prevalence rate of PAH was reported 36.6% in this study. There was no signiﬁcant relationship between LVEF and RV parameters. LVEF was found to be signiﬁcantly higher in women whereas RV strain turned out to be higher inmen. Besides, there was a signiﬁcant relation between pulmonary arterial pressure (PAP) and Basal (P = 0.03),mid RV strain (P = 0.002), RV strain rate (P = 0.001) and RV diameter (P = 0.02). Also, an inverse relationwas observed between RV systolic (P = 0.01) and diastolic functions (P = 0.007) with PAP. In addition, no signiﬁcant relationship was found between LVEF and bodymass index (BMI) and RV parameters (P > 0.05). Moreover, Apical RV strain and LVEF were found to be higher inmales and females respectively. Furthermore, a signiﬁcant relationshipwas found between RV strain and age (P = 0.027). Finally, the results did not show any relationship between RV systolic and diastolic functions and gender. Conclusions: This paper states the likely advantages of strain and strain rate echocardiography in identifying patients withmore diﬀused and severe SSc and the need for further longitudinal studies based on thementionedmethod for early diagnosis ofmyocar- dial impairment.

https://journal.razavihospital.ir/article_113506_dcd5211a30daec1c3c68c884dd2fd1e4.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 4 3 2016 07 01 The Relationship Between Some Teaching Micro Skills During Classroom Teaching and the Level of Students’ Learning 13 16 113507 10.30483/rijm.2016.117392 EN Majid Akbari Associated Professor of Restorative Dentistry, Center of Excellence inMedical Education Technology,Mashhad University of Medical Sciences,Mashhad, IR Iran Atefeh Nemati-Karimooy Assistant Professor of Restorative Dentistry, Department of Restorative Dentistry, School of Dentistry,Mashhad University of Medical Sciences,Mashhad, IR Iran Fatemeh Zourmand Ghasemi Dentist,Mashhad University of Medical Sciences,Mashhad, IR Iran Journal Article Background: Achieving the characteristics of eﬀective teaching can play an undeniable role in assurance of education. Objectives: The aimof this studywas to assess the relationship between some teachingmicro skills during classroomteaching and the level of students’ learning. Methods: At the beginning of this cross sectional study, a list of professors’ behavioral-verbal characteristics during classroom teaching, whichmight lead to amore eﬃcient learning, was prepared. These items were checked according to the check list by two students after attending the class. At the end of each session, an examwith appropriate validitywas held to evaluate the amount of learning. The correlation between the students’ scores and the teaching skills of the professor was analyzed through SPSS software ( = 0.05). Results: A signiﬁcant correlation was found between “Absence of mumble in the class” (P = 0.015), “fun atmosphere in the class” (P = 0.032), “notmerely reading the slides by the professor” (P = 0.003), “mentioning the objectives at the beginning of each session” (P = 0.011) and “lack of voice monotony” (P = 0.023), and the increase in the mean of students’ scores. However, there was not a signiﬁcant relationship between designating a break time during teaching period (P = 0.120) and “the rate of teaching” (P = 0.774) with themean of student’s achieved scores. Conclusions: According to the conditions of this study, the ability to control the class in terms of absence of mumble, establishing a fun atmosphere, not merely reading the slides by the professor, mentioning the objectives at the beginning of each session and lack of voicemonotony increase the learning level in classroomteaching.

https://journal.razavihospital.ir/article_113507_ce43c529910ddf02267c94b7180ae054.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 4 3 2016 07 01 Service QualityMeasurement of the Student Counseling Center Using SERVQUALModel 17 22 113508 10.30483/rijm.2016.117393 EN Arezoo Zarebi University of Bojnord, Bojnord, IR Iran Hadi Abbassi Department of Educational Sciences, Counseling and Guidance, University of Bojnord, Bojnord, IR Iran Ahmad Heydarnia Department of Educational Sciences, Counseling and Guidance, University of Bojnord, Bojnord, IR Iran Journal Article Background: The services that student counseling center present play an important role in students’ psychological health. There- ore,measurement of services quality can contribute to a higher quality of these services. Objectives: This studywas conducted in order tomeasure service quality of student counseling center at the university of Bojnord. Methods: In this cross-sectional descriptive research participated 253 students who referred to student counseling center at the university of Bojnord fromMarch to June 2015. A questionnaire adapted to SERVQUALmodel was used to collect the data. Wilcoxon signed-rank test was used to analyze the data. Results: The result of this study showed that there were some diﬀerences between students’ perceptions and their expectations of counseling services quality (Z = -12.91; P < 0.0001). The result also indicated that therewere signiﬁcant diﬀerences between students’ perceptions and expectations in all of the ﬁve dimensions of SERVQUALmodel. Themost signiﬁcant gapwas related to the tangibles and the less signiﬁcant one was related to sympathy dimension. Conclusions: By studying the gap between perceptions and expectations of students fromcounseling services, we can provide the base for developing appropriate programs for the improvement of counseling services.

https://journal.razavihospital.ir/article_113508_00f5988b3068176c62639caeae323b64.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 4 3 2016 07 01 Telemedicine Acceptance and Implementation in Developing Countries: Beneﬁts, Categories, and Barriers 23 29 113509 10.30483/rijm.2016.117394 EN Mohammad Reza Hassibian Medical Informatics Department, Faculty of Medicine,Mashhad University of Medical Sciences,Mashhad, IR Iran Sepideh Hassibian Bio-technology Depatment, Islamic Azad University,Mashhad, IR Iran Journal Article Context: Distributing health care services in remote and rural areas have become a major health problem for many developing countries. Telemedicine presents solutions to developing countries for better disease prevention, diseasemanagement, emergency services and practicingmedicine in areaswith limited access to healthcare services and facilities. Although thewillingness of devel- oping countries to accept telemedicine and incorporate it into their health care systems is rising, due tomultidisciplinary and com- plicated characteristics of telemedicine, they will face challenges and barriers which will slow down their progress. This literature review attempts to explain the beneﬁts, categories and barriers for acceptance and implementation of telemedicine in developing countries. Evidence Acquisition: This studywas conducted in 2016. Themain questionwas howis the general attitude to the acceptance and use of telemedicine in developing countries and what problems they are facing for the use of telemedicine. To ﬁnd the solutions, we searched articles in two main databases, PubMed and Scopus, with the keywords and expressions related to the subject of the study (developing countries, telemedicine, tele-health, barriers, challenges, adoption, and acceptance). Totally, 103 articles were extracted. Duplicate articles andarticlespublishedbefore 1998were eliminatedandthe remaining oneswere screenedfor eligibility in accordance with subject of the study. The result was 47 articles from PubMed and 5 articles from Scopus. This review is based mainly on preliminary results, opinions and predictions. As limitations of our study, we limited ourselves to PubMed and Scopus databases and also reviewed articles only in English language. Results: The study did not ﬁnd any article that totally disagrees with the implementation of telemedicine in developing countries. Most of the articles contain positive points associated with the use of telemedicine with respect to the barriers and challenges. Conclusions: Despite hopeful progresses in telemedicine, developing countries are facingmany problems in theirway toward suc- cessful application of telemedicine. High cost and cultural resistance are considered as themain barriers for developing countries in their approach to apply telemedicine. Developing countries must be fully aware that investment in telemedicine will not in- evitably yield clinical or economic beneﬁts in short time. Theymust consider barriers and various outcomes of telemedicine before accepting and applying it.

https://journal.razavihospital.ir/article_113509_40008261639153ddde209b77e38b223b.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 4 3 2016 07 01 The Predictive Role of Early Trauma Dimensions on Self-Esteemin 11 - 13- Year-Old Students: Controlling the Role of Maladaptive Schema 30 35 113510 10.30483/rijm.2016.117395 EN Seyede Fateme Sajadi Young Researchers and Elite Club, Shiraz Branch, Islamic Azad University, Shiraz, IR Iran Yadolla Zargar Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran Leila Zare Islamic Azad University, Marvdasht Branch, Marvdasht, IR Iran Fakhri Tajikzadeh Department of Psychology, Shahid Chamran University of Ahvaz, Ahvaz, IR Iran Journal Article Background: Self-esteemis a stable sense of personalworthiness. There is insuﬃcient evidence fromthe available research to fully determine the relationship between self-esteemand early trauma. Objectives: This is a correlational study aims to investigate the relationship between early traumas as a predictor of negative self- esteemby controlling the eﬀect of maladaptive schemas in 11-13 year-old-student sample. Methods: 292 people (201 females, 91 males) with mean age of 12.33 were selected via multistage random sampling. Participants completed questionnaire on children’s depression inventory (CDI), childhood trauma questionnaire (CTQ), schema inventory for children (SIC) and provided demographic information. Analyzing data was done using correlation and stepwise regressionmeth- ods. Results: The results showed that emotional neglect and physical abuse are the best predictors of negative self-esteem. Additionally, the results revealedno evidence ofmaladaptive schemasmediating the relationshipbetweenearly trauma andnegative self-esteem. Conclusions: In general, the ﬁndings showed that emotional neglect and physical abuse are the best predictors of negative self- esteemin children and explain a considerable variance of survival index. Our ﬁndings also demonstrate thatmaladaptive schemas do not have any signiﬁcant eﬀect on the relationship between trauma and negative self-esteem.

https://journal.razavihospital.ir/article_113510_9827095ec2e26db4894fe8d3f068d3e0.pdf

Mashhad Razavi Hospital Razavi Journal of Medicine 3115-753X 4 3 2016 07 01 A Hierarchical Model for Autism Spectrum Disorder (HMASD) 36 39 113511 10.30483/rijm.2016.117396 EN Ghasem Sadeghi Bajestani Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, IR Iran Ali Sheikhani Department of Biomedical Engineering, Science and Research Branch, Islamic Azad University, Tehran, IR Iran Mohammad Reza Hashemi Golpayegani Department of Biomedical Engineering, Amir Kabir University of Technology, Tehran, IR Iran Farah Ashrafzadeh Paediatric Neurology Division, QaemHospital,Mashhad University of Medical Sciences,Mashhad, IR Iran Paria Hebrani Department of Paediatrics, Dr Sheikh Paediatric Hospital,Mashhad University of Medical Sciences, IR Iran Journal Article Background: Autismspectrumdisorder (ASD) is a severe behavioral disorder characterized by pervasive impairments in social in- teractions, deﬁcits in verbal and nonverbal communication, and stereotyped, repetitive patterns of behaviors and interests. Despite recent advances in identifying some genes that may cause autism, its underlying neurological mechanisms are uncertain. ASD is best conceptualized by considering the neural systems thatmay be defective in autistic individuals. Objectives: Here,we aimto describe a potentialHierarchicalmodel for ASD. This interesting presentedmodel is based on excitatory and inhibitory characteristics of cortico-cortical networks. Methods: Jasonmodel is one of themodels applied to produce EEG in cortical areas. In thismodel, a cortical area ismodeled with three subpopulations including: excitatory pyramidal cells (output), excitatory interneurons groups, input inhibitory interneuron groups bymeans of output connections (output connections are limited to cortical planes). The presented hierarchicalmodel for autism spectrum disorder (HMASD) is based on Jason model. HMASD is a hierarchical model of cortico-cortical networks as well as an excitation/inhibition model in sensory, mnemonic, social and emotional systems. In HMASD there are three kinds of outer connections including forward, backward and lateral connections, that their power is controlled by coupling parameters. Results: HMASD raises the possibility that ASD is related to excitation/inhibition imbalance in cortico-cortical networks. HMASD parameters are possible way for quantization imbalance quality. Conclusions: Themost eﬀected parts in ASD are lateral connections of HMASD. Two-sided connections which are completely sym- metric become more active, and cause extra synchronization. On the other hand, due to special characteristic of two-sided con- nections and their ability to simulate the same phased dynamics, they cause unnatural asymmetry in children’s EEG signal. These results are consistent with previous ﬁndings suggesting the association of EEG abnormalities in ASD with functional impairment of information interacted in cortical connections.

https://journal.razavihospital.ir/article_113511_229442eceda4cc3d4dcaf1fed6e24800.pdf