Journal of

Background and Aim: Candida species are among the most common causes of opportunistic fungal diseases. Among Candida species, Candida albicans is responsible for most infections. Having many strains, C.albicans is highly polymorph. C. dubliniensis is very similar to albicans species both morphologically and physiologically. For an infection to occur, cell wall proteins play an important role as they enable yeasts to adhere to host cells and begin pathogenesis. Therefore, we decided to extract these proteins and examine them through molecular methods of protein analysis. Finally we came up with the idea of a modified staining in our analysis.

Materials and Methods: Initially cell wall proteins of two C. albicansstrains (CBS 562 & PTCC6027) and one C. dubliniensis strain (CBS 7987) were extracted by using a solution of beta-mercaptoethanol and ammonium carbonate. After dialysis, SDS gel electrophoresis was performed on the protein extract. Bands were then visualized by using three different staining methods among which one method was modified by us.

Results: By using Coomassie Brilliant Blue staining method, proteins with molecular weight of 42, 66.2 and 200 kDa were detected. By using Silver staining method, proteins with molecular weight of 21.5, 28.5 and 37 kDa were detected. However, using combined staining methods visualized more bands resulting improved detection.

Conclusion: To answer many questions about fungal diseases, fungi cell wall proteins are necessary to be examined. A simple method to enhance such molecular studies is the use of a modified staining method that combines both Coomassie Brilliant Blue and Silver staining.

Background and Aim: Over the past decade, the number of private centers providing health care services in Iran has had a continuous growth and the highly competitive market in private hospitals industry has caused increasing pressure on them to provide services with a higher quality. The purpose of this study was to assess the quality of services being provided in private hospitals of Tehran as judged by patients.

Materials and Methods: This cross-sectional study was conducted in 2010 in Tehran. The study sample comprised 983 patients, randomly selected from 8 private hospitals. The survey instrument was the standard SERVQUAL questionnaire. Wilcoxon, t-test, and Kruskal-Wallis tests were used for statistical analyses.

Results: The total mean scores of patients' expectation and perception were 4.92 and 4.02, respectively. The highest figures were related to the tangible factors dimension and the lowest ones to the empathy dimension. The differences between the perception and expectation for all the 22 items and the 5 dimensions were found to be statistically significant(p< 0.001).

Conclusion: SERVQUAL is valid and reliable in hospital settings as a standard tool for the assessment of quality. The results of the present study have revealed the areas that need to be improved as far as the patients are concerned. Measuring the opinion of patients can help facilitate the provision of hospital services, and improve the quality of such services and patients' satisfaction.

Background and Aim: Hospitals are among the most important establishments providing health services, in which -- due to special hazards -- the observance of safety principles is of great importance. This research aimed to study the safety conditions at educational hospitals of Shiraz University of Medical Sciences(SUMS).

Materials and Methods: This cross-sectional descriptive study was conducted in all educational hospitals in Shiraz and their safety status was investigated using safety audit technique. To this end, audit checklists were prepared and completed through observation, interview with managers and officials of various departments as well as studying the related documents. Then, based on the realization of safety requirements, hospitals were classified into three levels of poor (lower than 50%), medium (5o-75%), and good (higher than75%).

Results: The mean realization of safety requirements in the studied hospitals was 58 percent. The highest and lowest levels of realization of safety requirements were related to radiation safety and safety management, respectively. Safety status was evaluated as poor in 25% and medium in 75% of the studied hospitals.

Conclusion: The safety conditions of the studied hospitals, especially as regards safety management, emergency response plan, and fire safety aspects were relatively poor. The most important reason for that was the lack of clarity of responsibilities and of safety organizational structure. To improve the safety status, hospitals are required to establish the Occupational Health and Safety Management System (OHSAS 18001).

Background and Aim: Internal Evaluation is a process of providing evaluative-descriptive information based on the value and significance of educational objectives, operations and results to direct decisions, responses, information and research processes.

Materials and Methods: In this research, studying the opinions of faculty members, students, and graduates, the educational system of Medical Laboratory Sciences Department at Tehran University of Medical Sciences (TUMS) was evaluated in the year 2010. The aim the study was to remodel and adjust the educational system with the society's needs and to promote the educational quality. The employed method was a cross-sectional, descriptive one and consisted of 10 procedural steps in eight sections dealing with the evaluated factors such as faculty members and students, and the satisfaction expressed by students.

Results: The results of the study showed that the average of the eight investigated sections was 70.6% for the Department of Medical Laboratory Sciences, which can be interpreted as desirable.

Conclusion: Internal evaluation can be considered as one of the best methods of improving the quality of education in the faculty of Allied Health Sciences School

Background and Aim: Paying attention to efficiency of cost and performance in hospitals as the largest and the most costly performing unit of the health care systems is very crucial. This study aimed to assess the efficiency of hospitals related to Yazd University of Medical Sciences (YUMS).

Materials and Methods: In this study, the efficiency of Hospitals of YUMS was assessed by Data Envelopment Analysis method during years 2000- 2008. The variables were of two types: output variables including the percentage of occupied beds, inpatient days and the number of surgical procedures and input variables were number of active beds, nurses, medical staff and other personnel. The data was analyzed using Deap2.1 software.

Results: Average of technical, management and scale efficiency of hospitals was 0.958, 0.986 and 0.963 respectively. We concluded that the capacity of efficiency promotion in hospitals is increasable up to 5%. In addition, the nurses as one of the most important input variables, had the most apparent slack inputs.

Conclusion: Although the level of efficiency was optimal and there was little unused capacity for increasing efficiency in hospitals, however, managers should plan to increase the efficiency. Finally, assessing the effect of variables such as service quality and patient satisfaction on hospitals efficiency is recommended.

Background and Aim: Human Giardisis infection is caused by the flagellate protozoa. Giardia lamblia, which lives in the small intestine, causing damage and may also cause gastrointestinal symptoms. This parasitic disease has a worldwide distribution and prevalence varies from 5% to 30%. The role of both humeral and cellular immune response in the host defense against parasites has proven. Since an immune response is directly affected by cytokine, study of cytokines changes in patients with giardiosis is of particular importance.

Materials and Methods: In this study the serum levels of IL-2 - 4 - 6 to 17 and 23 in patients and healthy subjects were measured and compared. Fasting blood samples were taken from the volunteers, ELISA was performed to measure cytokines.

Results: In this study, the amount of IL-2 and IL-6 in infected patients was significantly more than the controls, but IL-4 levels were significantly lower in infected individuals (P=0.0001). Also for the first time in people with giardiasis IL-17 and IL-23 was measured and there was a significant aifference in these cytokines between the infected patients healthy controls(respectively P=0.044 and P=0.03)

Conclusion: Host defense response against parasitic infections, is directly and affected by cytokines. Increased interleukin 2, 6, 17 and 23 in patients with Giardiosis was probably caused by immune response and local intestinal inflammation.

Background and Aim: Achievement-based evaluation is an important part of the educational planning process, in which learners are screened besides, it helps teachers in their self-evaluation. The purpose of present study is to survey the methods through which laboratory sciences students were evaluated by their professors at Tehran University of Medical Sciences(TUMS) in the academic year 2009-2010.

Materials and Methods: In this cross-sectional study, the population consisted of the faculty members who teach laboratory sciences courses. Data collection instrument was a researcher-made questionnaire. The collected data were analyzed to describe all evaluation methods using tables and necessary distribution frequencies. Then, the results were compared with those of Medical Planning Council resolutions.

Results: The results show that mid-term exams were used for the evaluation of students in 35% of all theoretical and practical courses. Besides, of the evaluation methods used, multiple-choice questions occupied the first rank(70%) among the methods normally employed.

Conclusion: According to the results, routine evaluation of undergraduate students of laboratory sciences at the Paramedical Faculty of Tehran University of Medical sciences not only conformed to the ratifications of the Supreme Council of Medical Planning, but also was done more extensively and with a higher degree of consistency in the academic year 2009-2010.

Background and Aim: Medical Laboratory Sciences is one of the important fields in Medicine that is closely associated with other disciplines in this group. This study aims to evaluate laboratory sciences curriculum in Iran and several countries worldwide.

Materials and Methods: In this research, data collection is based on documents and curriculum goals of countries. The data collected was analyzed using qualitative methods.

Results: Comparative study of curriculum courses of bachelor of Laboratory Medical sciences was done and compared with the number of basic and specific units in Iran and other countries.

The curriculum in Iran with Turkey and Australia is remarkably consistent. Internship units in hospitals have lower returns in compared to other universities in the world.

Conclusion: Laboratory Science curriculum in Iran is matched with developing countries. However, more attention to training units and projects to improve the quality of teaching laboratory sciences could be more effective.

Background and Aim: Onychomycosis or nail fungus infection has an increasing prevalence with many effects on patients’ social life and mental health dermatophytes, yeasts and non-dermatophyte molds are among the best known agents of fungal infections of nails. The purpose of this study was to determine the prevalence of non-dermatophyte molds using morphological (direct examination and culture) and molecular (PCR) methods in patients referring to Medical Sciences Mycology Laboratory in Tehran, Iran.

Materials and Methods: In this study, samples were taken from 170 patients. For direct microscopic examination (DME), 15% KOH solution was used for the culture of samples, Sabouraud dextrose agar media (S) was applied together with chloramphenicol (SC) and chloramphenicol and cycloheximide (SCC). Meanwhile, differential tests were done for mycological diagnosis (slide culture), and 28SrDNA amplification and sequencing were performed for suspect or unknown samples.

Results: Of the 170 patients, 74 cases (43.5%) had onychomycosis, of which 53 cases (71.62%) were female and 21 cases (28.38%) were male. Also, of the 74 cases of onychomycosis, 40 cases (54.05%) were reported candidiasis, 21 cases (28.37%) non-dermatophyte molds, and 12 cases (16.21 %) dermatophytes.

Conclusion: The prevalence of onychomycosis in this study was 43.5% and the application of polymerase chain reaction (PCR) technique in cases of false positive, false negative and long-term culture was valuable meanwhile, given that all the samples that had positive results in DME with negative cultures were positive in molecular tests, this study reveals the power of molecular techniques compared with culture method.

Background and Aim: In medical centers, after obtaining visceral clinical samples in suitable containers under certain circumstances, they are sent to mycology laboratory. Since sometimes it is impossible to test specimens immediately, therefore, they should be kept in the refrigerator. Thus, possibility of keeping samples, the confidently time of samples keeping in a refrigerator and the appropriate guidelines for the maintenance of visceral samples for clinical centers have a particular importance for practical purposes and are the aim of this study.

Materials and Methods: At first, the specimen was examined by KOH direct microscopic examination for detection of fungal elements. After primary culture of visceral samples on the Sabouraud dextrose agar with chloramphenicol (SC) medium, the samples were sequentially placed in a refrigerator at temperature 2-8 ºc for 1, 2, 24 and 48 hs and each sample with the specific mentioned time culturing was performed on the Sabouraud dextrose agar (S) and SC media. Then the results of growth were recorded.

Results: From 100 samples, 79 samples had grown, 20 samples with lack of growth and in 1 sample reduced growth were observed.

Conclusion: After 48 hours of cold temperatures (2-8 ºc) visceral fungal clinical samples are able to grow in culture media. So samples which were not tested immediately, could be stored at temperatures 2-8 ºc in the refrigerator.

Background and Aim: Evaluating and improving the employees’ quality of work life is one of the most important responsibilities of managers in each organization. The aim of this study was to design and prepare a questionnaire for evaluating the residents’ quality of work life and checking the validity and reliability of this tool.
Materials and Methods: We collected the questionnaires which were used for the employees’ quality of work life, and designed by Delphi method a comprehensive questionnaire for measuring residents’ quality of work life. This questionnaire was distributed two times with one-week interval between 14 residents of Tehran University of Medical Sciences and then the validity and reliability was assessed by α cronbach model. We used the 5 experts in the field of health care management, medical education and health economics to determine the validity of quality of working life questionnaire. The classification of cronbach's α for intra-rater reliability was: very good (0.9-1), good (0.8- 0.89), average (0.7- 0.79), bad (0.6-0.69) and very bad (under 0.59).
Results: The results of  αcronbach test for questions reliability and the result α cronbach test for internal consistency of each class of question indicated the rather high reliability and validity of these questions.
Conclusion: Regarding to the results of α cronbach test, we can deduce that our designed questionnaire encompass have satisfied validity and reliability and it can be used for future studies.

Background and Aim: Giardiasis is the most common pathogenic gastrointestinal parasite worldwide and transmitted by ingesting parasite cyst, through water and food and person-to-person contact. Therefore in food handlers and child care workers it is of high importance. In this study we surveyed the job of individuals with giardiasis.
Materials and Methods: This study was a pilot descriptive-analytic study. Hundred and nine stool samples were collected from individuals referred to medical centers affiliated to Tehran University of Medical Sciences for health certificate. 
Samples were examined with wet mount smear and formol-ether concentration methods. Also a questionnaire was given to each individual.
Results: Sixty nine samples were infected with Giardia lamblia. among positive samples for Giardia lamblia 25 (36.23%) were related to food handlers and occupations which are most  frequently associated with food, one (1.44%) nurse, one (1.44%) managing director of the nursery, two (2.89%) housekeepers  and one servant (1.44%).
Conclusion: Person-to-person Giardia lamblia transmission is often associated with poor hygiene and sanitation, most commonly by food handlers.
Also, day- care workers have a higher risk of infecting children attending day-care centers. Therefore particular attention should be paid to health of this workers as well as three times stool examination.