Original Article

International Hospital Performance Assessment: Developing a Questionnaire

Mona Mohammadnia, Kamran Hajinabi, Mahmoud Mahmoudi Majd Abadi Farahani, Ali Komeli

Novelty in Biomedicine, Vol. 6 No. 3 (2018), , Page 111-117

Background: As there is no valid questionnaire for assessing international hospital performance from providers’ perspective, this study aimed to develop a reliable as well as valid questionnaire for Iranian hospitals.

Materials and Methods: To develop the International Hospital Performance Assessment (IHPA) questionnaire, literature review did and comparative study conducted for extracting relevant items from twenty leader hospitals in all over the world. After that, to design the questionnaire and estimate its content validity index and ratio (CVI, CVR), 20 medical tourism experts selected. Then, questionnaire‘s construct validity (CVI & CVR) determined by using SPSS version 21 as well as exploratory factor analysis. Finally, reliability assessed by calculating Cronbach’s alpha coefficient.

Results: The content validity of the questionnaire determined as (CVI= 0.85, CVR= 0.60). According to expert opinion 5 dimensions of the questionnaire selected from World Health Organization hospital performance framework, which were clinical effectiveness and patient safety, efficiency, patient centeredness, governance responsiveness and even staff orientation. Furthermore, results of exploratory factor analysis showed that the questionnaire contained 45 items and Cronbach’s alpha coefficient was 0.687.

Conclusion: Results indicated that standard IHPA questionnaire with 45 items in 5 dimensions developed as a tool for measuring hospitals’ quality of care in Iran.


Background: Pseudomonas aeruginosa (P. aeruginosa) is one of the main causes of nosocomial infection. Burn patients are at high risk of acquiring this bacterium due to skin damage and their immune deficiency, and mortality rate in these infected patients is high (40-50%). Therefore, due to antibiotic resistance of MBL containing strains in this bacterium, the aim of this study is to investigate the effect of methanol and acetone of Zataria multiflora, Capsicum annum L. and Piper nigrum L. on strains containing MBL in this bacterium.

Materials and Methods: This lab study was conducted on samples from burn patients, which were gathered between 2015 and 2016. In this study first, disc diffusion and MIC were done based on the CLSI protocol; and using a combined disk, we detected metallo-beta-lactamase. Next, the bla (IMP) and bla (VIM) genes were identified by the PCR method. In order to investigate the effect of three plants extract on bacteria, the bacteria was affected by triple extracts using MIC and disk diffusion.

Results: According to the results, all three plants had an acceptable effect on Pseudomonas aeruginosa strains containing metallo-beta-lactamase, and to be more precise, the acetone type of extract of Capsicum Annum L at a concentration of 1.5 mg / ml had the best effect in treating of these bacteria.

Conclusion: The results of this study indicate the presence of several mechanisms of resistance to beta-lactam antibiotics among Pseudomonas aeruginosa strains collected from burn patients. The emergence of these types of XDRs has led to health problems, especially in burn patients. According to the results, the methanolic and acetonic extract of all three plants have been shown to be effective in inhibiting the growth of MBL-containing Pseudomonas aeruginosa.

The Inhibitory Effects of Lactobacillus Reuteri’s Cell Wall on Cell Proliferation in the HCT-116 Colorectal Cancer Cell Line

Zahra Rafiei Atani, Ebrahim Faghihloo, Zohreh Ghalavand, Gita Eslami

Novelty in Biomedicine, Vol. 6 No. 3 (2018), , Page 126-130

Background: Colorectal cancer (CRC) is the third and a second common cancer in men and women respectively in the world and about 1.4 million new cases diagnosed in 2012. The normal gut microflora consists of bacterial species. One group of them is probiotics, which confer a health benefit to the host. Lactobacillus reuteri (L.reuteri) is known as a probiotic, which lead to the prevention of colorectal cancer. The aim of this study was to assess the inhibitory effects of Lactobacillus reuteri’s cell wall on cell proliferation in the colorectal cancer HCT-116 cell line.

Materials and Methods: The cells of HCT-116 cell line were grown at 37ᵒC, 5% CO2. L.reuteri was obtained from the Iranian Biological Resource Center and cultured in the MRS Broth at 37ᵒC for 48h anaerobically. The cell wall was prepared by the freezing-thawing procedure. So the inhibitory effect of L.reuteri on the growth and proliferation of HCT-116 cells was assessed by MTT assay.

Results: The cell wall from L.reuteri inhibited cell proliferation on colorectal cancer HCT-116 cell line. It showed dose- and –time dependent inhibition.

Conclusion: These results demonstrated that cell wall of L.reuteri inhibits cell proliferation of HCT-116 cell line.

Determining Induction Conditions for Expression of Truncated Diphtheria Toxin and Pseudomonas Exotoxin A in E. coli BL21

Sahel Amoozadeh, Maryam Hemmati, Mohammad Morad Farajollahi, Neda Akbari, Parastoo Tarighi

Novelty in Biomedicine, Vol. 6 No. 3 (2018), , Page 131-137

Background: Targeted cancer therapies have played a great role in the treatment of malignant tumors, in the recent years. Among these therapies, targeted toxin therapies such as immunotoxins, has improved the patient’s survival rate by minimizing the adverse effect on normal tissues, whereas delivering a high dose of tumoricidal agent for eradicating the cancer tissue. Immunological proteins such as antibodies are conjugated to plant toxins or bacterial toxins such as Diphtheria toxin (DT) and Pseudomonas exotoxin A (PE) . In this case optimizing and expressing Diphtheria toxin and Pseudomonas exotoxin A which their binding domains are eliminated play a crucial role in producing the desired immunotoxins.

Materials and Methods: We expressed the truncated DT and PE toxin in a genetically modified E.coli strain BL21 (DE3). For this reason we eliminated the binding domain sequences of these toxins and expressed these proteins in an expression vector pET28a with the kanamycin resistant gene for selection. The optimization of Diphtheria toxin and Pseudomonas exotoxin A expression was due to different IPTG concentration, induction and sonication time.

 Results: We observed that the optimal protein expression of the Diphtheria toxin was gained in 4 hours of 0.4 mM IPTG concentration at 25˚C on the other hand the optimization of Pseudomonas exotoxin A protein occurred in 4 hours of 0.5 mM IPTG concentration at 25 ˚C.

Conclusion: Our study also showed lower IPTG concentrations could result in higher protein expression. By optimizing this procedure, we facilitate the protein production which could lead to acceleration of the drug development.

Background: In our previous study, the extract of Trachyspermum copticum (L.) Link seeds on gene expression of IFN-γ and TGF-β1 in mouse model with irritant contact dermatitis (ICD), in comparison with cutaneous corticosteroids were evaluated. In that study, in addition to significantly increase of IFN-γ and TGF-β1 genes expression levels in skin samples of "mice with ICD" groups treated with extract in comparison to other groups, histopathologic findings showed substantial improvement of skin color, texture and thickness, and also significant increase in hair follicle number. Therefore, we have decided to study the levels of Interleukin-1 (IL-1) gene expression, which plays a major role in inflammation responses, and Keratinocyte Growth Factor/Fibroblast Growth Factor-7 (KGF/FGF-7), which has growth effect on cells and is an important endogenous mediator of hair follicle growth and development.  

Materials and Methods: We used autopsy samples of skin lesions obtained from "mice model with irritant contact dermatitis (ICD)" from the previous study. In that study, "mice with ICD" divided in 9 groups and were treated with three concentrations of Trachyspermum Copticum (L.) Link dried seeds, cutaneous hydrocortisone, and fluocinolone acetonide. Then from the first day until the 10th day of treatment, clinical signs and histopathologic investigations were investigated. In the present study, using Real-Time PCR, the levels of IL-1 and KGF/FGF-7 genes expression in skin samples of inflammation site in above mice groups were studied. Statistical analysis, using one -way ANOVA, were performed. Level of significance was set at 0.05.

Results: The IL-1 gene expression showed a significant difference between groups: IL-1 gene expression levels in mice with ICD treated with extract and corticosteroids were higher than the other groups (p=0.0001). While in untreated "mice with ICD", no significant differences were observed. Also, during the treatment, there was a considerable increase in levels of IL-1 gene expression in groups treated with the extract at a rate of at least 2 to 3-fold in comparison with the "healthy untreated mice" group. The levels of KGF/FGF-7 gene expression in "mice with ICD" groups treated with the extract showed significance difference (p=0.014); also there was a meaningful difference in "mice with ICD" groups treated with cutaneous corticosteroids (p=0.004). While, in "untreated mice with ICD" group there were a significant decrease in the levels of KGF/FGF-7 gene expression in comparison with "healthy untreated mice" group (p=0.0001). Also, changes in the levels IL-1 and KGF/FGF-7 gene expressions in each group in different days were seen.

 Conclusion: In this study, significant changes in the IL-1 and KGF/FGF-7 genes expression levels in the skin samples with inflammation, were associated with an increase in the rate and speed of improvement of contact dermatitis, more favorable conditions of the healed skin (in terms of color, consistency, and thickness), and a remarkable increase in the number of hair grown on the site of dermatitis (compared with control groups, and even groups with corticosteroid therapy).


Using nucleotide sequencing to determine HBV genotypes in Kerman

Najibe Monemi, Masoumeh Hajirezaei, Nasrollah Saleh-Gohari

Novelty in Biomedicine, Vol. 6 No. 3 (2018), , Page 147-151

Background: Hepatitis viruses are one of the serious medical problems and Hepatitis B is one of the chief transferable disease via blood and its products. Nowadays, 11 genotypes of hepatitis B have known over the world by the genome sequencing. Hepatitis B viruses have special geographical distribution. The clinical importance of hepatitis B viruses and its relation with the mutations has recognized. The purpose of this study was to check the presence and prevalence of Hepatitis B virus genotypes among the referrals attended to the medical diagnostic laboratories in Kerman province.

Materials and Methods: In this cross-sectional study, twenty-one specimens were collected from blood samples available in the medical diagnostic laboratories of Kerman province during one year. After DNA extraction, PCR was carried on by specific primers, then they were sequenced. The obtained sequenced were compared with sequences in the NCBI gene bank and blasted for identification of their genotypes.

Results: Seven samples from twenty one samples (33.3%) had D genotype, 13 samples from 21 (62%) had D3 subgenotype and 1 sample from 21 (4.7%) had D4 subgenotype.

Conclusion: The prevalence of these genotypes in the Kermanian patients that recognized in this study can help to provide diagnostic kits for hepatitis B virus.

Keywords: Hepatitis B virus, genotype, PCR, Sequencing, NCBI.

Case Report

Borreliosis: Early Diagnosis based on Clinical Suspicious

Marzieh Davari, AmirHossein Moghtader Mojdehi, Sahar Babaali

Novelty in Biomedicine, Vol. 6 No. 3 (2018), , Page 152-154

Background: Lyme disease, (LD) is the most common tick-born disease. It is caused by borrelia burgdorferi. Lyme disease is a systemic illness. It can involve different organs, causing a large variety of clinical manifestations. LD is potentially lethal in chronic and late stages, so it is important to consider the antibiotic therapy at early stages.

Cases Report: Here we present a 29-year-old young woman who was admitted to the hospital with fatigue. She claimed to be bitten one day before the admission. She was otherwise a healthy individual.

Conclusion: Through this reported case, we highly recommend the early clinical diagnosis of Lyme disease in endemic areas.

Letter to editor

Prevalence of HIV Infection among Hemodialysis Patients

Davood Yadegarynia, Sara Rahmati Roodsari, Zahra Arab-Mazar

Novelty in Biomedicine, Vol. 6 No. 3 (2018), , Page 155-156

Human immunodeficiency virus (HIV) belongs to human retrovirus family and transmitted by blood transfusion and blood products. 36.9 million People were living with HIV infection worldwide in 2014 approximately1, during which 2 million (1.9–2.2 million) new infections with HIV had occurred. End-stage renal disease (ESRD) patients treated by hemodialysis (HD) are more susceptible for infection by human immunodeficiency virus infection. Renal failure can be an associated condition or could be a direct consequence of HIV infection2,3. Advanced HIV disease which is indicates by a low CD4 cell count is development of renal diseases subsequently4, however many other causes now may cause renal failure in patients with HIV, including drug-induced toxicity, hypertensive nephroangiosclerosis, and diabetes5. HIV infection and hemodialysis have same consequences such as cardiovascular diseases, immunosuppression, anemia, weight loss, and osteodystrophy6,7.

Compared with rate of infection with other viral infection such as hepatitis B virus (HBV) or hepatitis C virus (HCV), the risk of HIV infection among hemodialysis patients is lower as the contact with contaminated sources.

Although intensive HIV research has been done for 20 years, we have a little knowledge about mortality risk factor in ESRD on HIV-infected patients. Hemodialysis patients who have HIV-infected are assumed to a high risk for death4.

The finding the current study demonstrated the prevalence of HIV in hemodialysis patients which was conducted in 5 hemodialysis centers in Tehran province, Iran, in the 2016. All the enrolled participants were informed about study and written informed consent was obtained. Statistical analysis was performed by SPSS version 16 (SPSS Inc, Chicago, IL, USA). 

Among 360 patients, 213 (59.17%) of patients were men and 147 (40. 83%) were females; the mean age of patients was 53.43. HIV Ab was negative in all cases. This result has been confirmed in other studies as well8. The highest frequency for duration of dialysis is 1-5 years.

Nowadays viral transmission via hemodialysis routes is controlled and limited since more effective screening of blood donor. Screening and early diagnosis of kidney disease will improve outcomes in patients with HIV infection.

Considering all of these evidences, further studies are recommended strongly to evaluate the real prevalence of HIV in these patients.