محمدرضا اخلاقی

A proper understanding of tourists' spending patterns makes it possible for policy makers, planners, marketers and researchers to examine the economic interaction of tourists with the destination community. Families are the main consumers of tourism products; Therefore, it is important to understand and explain the characteristics of household consumption and the factors affecting it, so that tourism policies and marketing strategies are well adopted. The basic question in this research is whether the amount of money spent by Iranian households per household member on domestic trips undergoes significant changes due to economic, demographic, psychological and travel-related characteristics; And to what extent do these factors determine the cost? This research, using a systematic approach at the level of micro-economics, has answered this question and tries to encourage other researchers to enter this issue. The data of this research includes the economic, demographic and psychological characteristics of 628 Iranian households and information related to their last domestic trip until the end of 2018 and before the official outbreak of the corona virus in Iran. The results of this research show the influence of the amount of expenses of the households on the indicators of income, age, education and the type of occupation of the caretaker, the number of dependent and independent children, the number of family members on the trip, the use of a private vehicle and staying at relatives' houses during the trip and the importance Recreational trips are in the consumption basket of the household. Also, after comparing the amount of expenditure of households in different stages of the household life cycle, it was found that the stages of couples without children, single, the third phase of full nest and single parent, respectively, have the highest amount of expenditure on tourism, and the least amount belongs to widowed households. . At the end, suggestions were presented in order to increase financial circulation and benefit as much as possible from the supply chain of tourism in Iran, which can be a suitable guide for future policies in tourism.

Sustainable development in the tourism sector requires the existence of infrastructure and facilities for tourism, including a range of structures, basic institutions, and service institutions that facilitate and promote travel. One of the important challenges of tourism development in Iran is the lack of distribution of these infrastructures and facilities in a balanced way at the national and provincial levels. Most of these infrastructures are concentrated in several important provinces, especially in large cities. This issue has led to the main direction of tourism flow to these destinations, the neglect of many potential tourism destinations, and consequently, the lack of fair distribution of benefits and revenues from tourism at the national and provincial levels. In this study, we tried to use a  method including reviewing previous studies and development policies in Iran and also analyzing the upstream tourism documents, data extracted from statistical yearbooks, and comparative studies of other countries, to identify the current distribution of tourism infrastructure in a geographical area and also provide solutions for the development of such infrastructure throughout the country with a balanced and justice-oriented approach. In this way, the role of the tourism industry in the economic prosperity of the less privileged areas of the country, employment, and creating welfare for the residents of these areas can be highlighted

Age-related macular degeneration (AMD) is one of the disorders in the retina that causes central vision disorders. Optical coherence tomography (OCT) images are used to diagnose this disease, and given the changes in the disease caused by elevations in the retinal pigment epithelium (RPE) layer of the retina, the complication is diagnosed.

In the proposed method, the starting point of the RPE layer was labeled by the user on a limited number of OCT slides to eliminate the possibility of mistaking other layers such as the retinal nerve fiber layer (RNFL). The graph-based algorithm was then applied to the image in low width parts; an algorithm was used to maintain the continuity of the parts to eventually estimate the location of the RPE layer. With a similar algorithm, the bruch layer was also located at each scan, and by estimating the distance of the two layers, PED elevations were identified.

The proposed method was evaluated on three datasets with 35, 15, and 10 patients. Compared to the graph-based method in the first, second, and third datasets, respectively, the unsigned error in the RPE layer improved from 4.3392 to 2.7827, 3.3340 to 2.1623, and 6.4842 to 2.3924 pixels, and the bruch layer improved from 5.7576 to 4.8473, 4.3353 to 2.6023, and 6.67 to 2.5446 pixels, respectively.

The proposed method is valid in PED images, and can be effective in diagnosing AMD.

One of the main challenges of government organizations in Iran is the selection and management of human resources. This weakness is due to factors such as mismatch between job and employee and also lack of transparency in the job description of each position and communication missions of the organization, which leads to problems such as inefficiency of the organization, lack of job commitment, job dissatisfaction, leaving the job, re-employment. And will waste resources and time. This study examines the current situation in the municipality of Tehran's 7th district with 908 employees in various specialized fields, in which the current process of selection and relocation of human resources is formed based on the personal recommendation or taste of individuals; Also, while using the documentary studies of the relevant organization and designing worksheets to measure the level of knowledge and mastery of the employees of each unit on job descriptions and how they perform in order to achieve the goals and missions of the organization, using descriptive-analytical method, Urban and environmental describes the organization on a case-by-case basis and offers solutions for improvement. The statistical population of this study includes all employees of Tehran Municipality, District 7, and the method of implementing the plan is a census of all employees. Given the crucial issue of re-engineering job descriptions, which most organizations today use this approach to improve productivity and satisfy their stakeholders, the results of this study can be an important and vital tool for managers to make decisions in the field of urban management. The experimental results of this study show that although the distribution of organizational forces and tasks is apparently and efficiently formed in the surface layers of the organization with the least challenge, but when we take a closer look at the situation and deeper layers, we notice ruptures. This seems to be the case in most areas of Tehran.

The aim of this study was to determine the effectiveness of diode MicroPulse laser for improving visual acuity in patients with acute central serous retinopathy. In this clinical trial study, 26 patients with acute central serous retinopathy were selected and divided into two groups of 13; the first group was treated with diode MicroPulse laser; and in the second group, no intervention was performed. Patients in both groups were followed for three months, and visual acuity and recovery were compared between the two groups. The visual acuity (logMAR) before the start of treatment and at the 4th and 12th week of treatment did not show a significant difference between the two groups. In intragroup examination, visual acuity (logMAR) in both groups was significantly different (P < 0.01), but there was no significant difference between the two groups in the intergroup analysis (P = 0.82). Although the results of this study indicate that diode MicroPulse laser improves clinical and anatomical results in patients with acute central serous retinopathy, there is no statistically significant difference compared with spontaneous improvement of these patients.

The production of oil and gas in oil and gas fields is accompanied by production of water (Produced Water). Most of the reservoirs at the beginning of production have fresh water; but with passing time due to the increase in productions and decrease in pressure of reservoir, the produced water gradually becomes saline. The saline Production water causes severe corrosion in pipelines and well head facilitis leading to reduction in gas production. Determining the origin of salinity for reducing the salinity is most important. Khangiran gas field is located in the northeast of Iran which composed of two separate gas formations, Mozduran at lower and Shurijeh at the upper part. The produced water samples were collected from fresh and salty wells in the Mozduran reservoir as well as two deep samples from brine below the gas reservoir (at depth of 3 km) for comparison and different analyzes. The Mozduran reservoir has two major problems, high salinity of the produced water, as well as the volume of water produced, rendering some wells unexploitable. The results revealed that two deep water samples have different behaviors. The deep sample No. 17, taken at a higher elevation than sample No. 13, showed the signs of salt dissolution; whereas the brine from sample no.13 had the origin of the evaporated old sea water. Therefore, any of these brines in the Khangiran reservoir can be the possible source of salinity in produced waters. The saline produced water samples showed a similar behavior to brine sample no.13. The source of fresh produced water is also the condensation of water vapor in the reservoir during production.

The Mozduran gas reservoir in the Khangiran gas-field is formed in the Kopet-Dagh sedimentary basin in the form of sequential sequences of clastic and carbonate sediments of the old sea water. The reservoir is located in the formations of Shurijeh and Mozduran, consisting of limestone, dolomite, sandstone and shale. The Mozduran Formation was deposited in a carbonate platform and Shurijeh Formation in the river systems to coastal deltas during the Jurassic. The origin of brine formation waters was the old evaporated seawater. The old evaporated seawater has been in contact with various formations since the burial time, and their initial composition has altered. Ion concentration of major, minor and trace elements in the produced waters and two deep brine samples below the Shurijeh reservoir were measured to investigate the geochemical evolution of the brine formation waters. The concentration of all ions has increased to saturation in brine due to the evaporation of sea water. However, over the time, the concentrations of Ca, Li, Sr, B and I ions have been increased compared to the original source and the concentration of Na, Mg and SO4 ions have been decreased. The geochemical evolution of this reservoir has been affected by evaporation, water-gas and water-rock reactions such as dolomitization, albitization of plagioclase, ilitization of Smectite, sedimentation or dissolution of sulfate minerals, magnesium carbonate precipitation. Concentration of potassium and chloride ions was mainly influenced by the process of evaporating the old sea water. The results of this research are used to identify the history of sedimentation, secondary geochemical processes in the reservoir, determination the origin and the salinization mechanism of produced water from the gas reservoirs area to achieve sustainable management of the reservoir. The concentrations of brine formation waters reflect both the chemical characteristics of the sources from which they originated and the diagenetic reactions that had taken place. The modified original seawater, locked in during the time of sedimentation, is proposed as an origin of most deep saline formation waters. The evaporated seawater has been in contact with various formations in oil/gas fields since the time of burial. The chemistry of produced water in oil and gas reservoirs can be changed over the time by various processes and secondary reactions such as water-rock and/or water-gas interactions. The study area, Khangiran gas field, is located northwest of Iran. This gas field composed from three reservoirs of Mozduran, Shurijeh B and Shurijeh D. Mozduran reservoir consists of thick layer of carbonate rocks and interlayers of marl and shale. According to geological, hydrochemical and isotopic studies, the old evaporated sea water is proposed as main origin of the produced water and salinity. Over the time, the effect of various secondary processes inside the reservoir has caused a change in the initial concentration of the main ions of the brine relative to its original source (evaporated sea water). The main agent of this research is to investigate the geochemical evolution of the brine below the Mozduran gas reservoir and also to identify the secondary processes that affect its chemical composition during the geological times. Two brine water samples were taken from observation well no. 13 and 17 which drilled to Shurijeh B and D reservoir. The water content in the wellbore was drained by gas flow and after that, the brine sample was brought to the surface from a depth of 3000 m below sea level using a bottom-hole sampling device. In this study, the 6 samples are also taken from saline and fresh produced waters of the Mozduran gas wells to measure the concentration of major ions and trace elements. The trace elements, and Br and I anion concentrations were analyzed by ICP-MS, ICPOES and IC techniques. Various methods have been used to investigate the geochemistry evolution of the Mozduran reservoir. The water chemistry of brine formation waters can be altered by evaporation or water–rock interactions during burial. Br is conservative ions and cannot be easily removed from solution and used to study for geochemical evolution; therefore, Br ion concentration of Mozduran reservoir waters is most probably equal to the original Br concentration of its source, evaporated seawater. The brine and produced waters in the study area are enriched in Ca, Sr, Li, I and Rb, and depleted in SO4, Na and Mg ions, with respect to the initial evaporated seawater. Therefore, the seawater evaporation is not the only process controlling the geochemical composition of the brines in the area. The ion concentration variations are due to processes such as sulfate reduction, anhydrite precipitation, organic material-water reactions, limestone dolomitization, and albitization of plagioclase feldspar.  Based on the chemical evolution after seawater evaporation, the KA waters are classified into four groups: (1) no evolution (Cl, K ions), (2) water-rock interaction (Na, Ca, Mg, Li and Sr ions), (3) water-gas interaction (SO4 and I ions) and (4) both water-rock and water-gas interactions (Mn and B ions). The chemical evolution processes of the KA waters include dolomitization, precipitation, ion exchange and recrystallization in water-rock interaction. Bacterial reduction and diagenesis of organic material in water-gas interaction also occur. Therefore, the concentration of all ions increases due to the evaporation of seawater up to saturation, but some of the ions’ concentrations have changed under the influence of rock/gas-water interactions. The chemical evolution of the brine waters is classified into four groups: (1) only evaporation, (2) water-rock interaction, (3) water-gas interaction and (4) the interaction of both rock and gas with water.

The fruit flies and cucurbit weevil are the most important pests of melon which reduce the quantity and quality of the product. Several different synthetic insecticides have been used to control melon fruit pests by farmers. To reduce the use of chemical insecticides, application of non-chemical methods were tested in the melon farms in Semnan region in 2014. Fruit cover with paper and cloth net, kaolin clay (Sepidan® WP 95%, 50000 ppm), mixture of kaolin (50000 ppm) and sulfur (WDG 80%, 10000 ppm), mixture of kaolin (50000 ppm) and azadirachtin (Nimarin® EC 15%, 2500 ppm), and dimethoate insecticide (Roxion® EC 40%, 1500 ppm) were sprayed over the whole canopy of melon. Based on the field studies, fruit covering and kaolin application deterred oviposition and reduced the fruit pest's damage. The percentage of oviposition deterrence for fruit flies and cucurbit weevil, were 93.4, 78.2 for fruit cover with cloth net treatment and 83.5 and 38.2 for mixture of kaolin and sulfur treatment, respectively. The percentage of damage reduction for melon fruit pests, were 11, 14, 22, 25 and 86 in cloth net cover, paper cover, mixture of kaolin and sulfur, kaolin and control treatments, respectively. Also, the results show that the fruit weight was increased in the kaolin treatments. Therefore, application of fruit covers and mineral compounds such as kaolin and sulfur could be used successfully to reduce fruit pest oviposition and its damage on melon.

The aim of this study was to evaluate the epidemiological characteristics of deep vitrectomy surgery at the Feiz Ophthalmology center in Isfahan, Iran.
This was a retrospective descriptive study on patients underwent deep vitrectomy in Feiz Medical Center during 2011 to 2015. Reviewing patient's medical records and information including demographic data was done and the data were analyzed.
Findings: In this study, 2437 patients undergoing deep vitrectomy were reviewed, with a mean age of 54.25 ± 17.40 years, of them, 56.4% were men. 35.2% and 37.2% of patients had visual acuity of hand motion and counting fingers, respectively. Vitrectomy was performed in right eye in 49.2% of the patients. The most common cause of vitrectomy was proliferative diabetic retinopathy (35.3%), followed by retinal detachment (29.3%). 7.5% of patients had a history of previous vitrectomy.
Deep vitrectomy surgery is common in ophthalmology centers and is more common in men, and in the age category of 50-70 years. Generally, proliferative diabetic retinopathy and retinal detachment were the most common causes of deep vitrectomy in this study.

The symmetricity of even organs of body may help clinicians in the early detection of diseases. So, we estimated the cup-to-disk ratio (CDR) in left and right eyes and checked the symmetricity between the two eyes using the data of optical coherence tomography (OCT).
In this study, data from 40 normal subjects were used. This data was taken from the 3D-OCT1000 Tapcon model. For estimating CDR in each B-scan, at first the internal limiting membrane (ILM) and retinal pigment epithelium (RPE) layers were extracted; then using the end-point of RPE layer and the depth of cup, the boundary of disk and cup were determined. Finally, CDR of each B-scan was compared point-by-point and the symmetricity parameters were evaluated.
Findings: CDRs in the left and right eyes of 40 normal data were investigated locally. We divided optic disk area into three regions named upper, middle and lower. Then, CDR of each region was calculated for left and right eyes of each patient. The local CDR were 0.433 ± 0.0548, 0.432 ± 0.061, and 0.432 ± 0.0635 for the right eyes and 0.441 ± 0.0635, 0.443 ± 0.0731, and 0.417 ± 0.675 for the left eyes in upper, middle and lower regions, respectively. The differences between local CDRs in different regions of the two eyes were 0.0483± 0.042, 0.0420 ± 0.039, and 0.067 ± 0.045, respectively.
The results of local comparison of CDRs between the left and right eyes indicated that the level of asymmetricity in the lower region of disk was higher than upper and middle regions, and the middle region has the most symmetricity. In addition, in point-by-point symmetricity evaluation of CDRs, the highest level of symmetricity is seen in the second B-scan, near the center of optic disk.

The retinal laser photocoagulation is the gold standard treatment of the proliferative diabetic retinopathy. Nowadays, we can perform panretinal photocoagulation with single spot or pattern scan laser methods. This study aimed to compare the retinal ischemic changes and the retinal neovascularization regression between these two techniques. In a prospective clinical trial study, 146 eyes of 73 patients with proliferative diabetic retinopathy was enrolled. One eye of patients was treated with single spot laser photocoagulation randomly and other eye was preserved for pattern scan laser photocoagulation. The changes of retinal ischemia on the basis of noncapillary perfusion and the regression of neovascularization on the basis of amount of leakage on fluorescein angiography were compared between the two groups after 6 months. There was no significant difference in the retinal neovascularization regression of disc and elsewhere in eyes treated with pattern scan (P = 0.26) or single spot laser (P = 0.31). While the areas of the retinal ischemia progression was significantly higher (9 cases) in group treated with pattern scan in comparison to other group (2 cases) (P = 0.02). The areas of retinal ischemia progression were higher after treatment with pattern scan laser compared to single spot laser. Future researches are recommended to find a better modality than the pattern scan to induce regression of the retinal ischemia similar to the single spot laser technique.

Optical coherence tomography (OCT) is a progressively important modality for the noninvasive management of retinal diseases، including age-related macular degeneration (AMD)، glaucoma، and diabetic macular edema. Spectral domain OCT (SD-OCT) generates 3-dimensional (3-D) volumes، which have proven to be useful in clinical practice. In this regards، forming projection images limited to each layer of retina not only represents information of each layer but also، it would individually display the amount of vulnerability in the each layer caused by a specific disease.

In the first step، a projection image associated with 11 retinal layers was formed with merging the levels and voxels between each pair of boundaries by using different statistical indicators including average، mean، maximum and minimum. Then، retinal layers with more information through statistical indicators were fused with each other to gain an image without any noise and other deficiencies to possess a better clarify and contrast of specific information in X-Y axis.

Using different statistical methods such as average، mean، maximum، minimum and variance، projection images associated with each layer of retina were gotten. Each of these methods made better images in the specific layers than other methods used in the next steps. Fusing of layers with each other was also provided appropriate information from retinal depth in different parts. Contrast enhancement of images related with layers of fused images and creating more complete coordinate of vessels presence were important characteristics of final image.

Resulting projection image would be used more effectively in the extraction of important characteristics of retina including vessels extraction as well as determination of confinement and the center of macular region. Moreover، newer multi-resolution transforms such as curvelet transform would be used to obtain better final fused image.

Human growth hormone (hGH) is a secretory protein of the blood which is used extensively in biotechnology and medical sciences. Recombinant human growth hormone production is still one of the priorities of the Iranian Ministry of Health. One of the most sensitive and accurate techniques for the measurement of this hormone is the ELISA method. Scientists need to produce antibody against hGH to measure the serum level of hGH in patients. Commercial ELISA kits are commonly imported from other countries to Iran. Therefore، the current study aimed to produce a polyclonal antibody against hGH in order to make a domestic ELISA kit to measure this hormone.

Rabbit polyclonal antibody against hGH was produced following 10 weeks of immunization by the antigen injection. The antibody characteristics were evaluated by immunoblotting. The purified antibody was used to design the ELISA kit. The designed sandwich ELISA method was standardized concerning the amount of antibody coating and antibody conjugate. Ultimately، the sensitivity and specificity of the designed kit was compared with the foreign kits.

The polyclonal antibody against hGH was produced in rabbits and purified successfully. This antibody can be used in the western blot and ELISA methods. The diagnostic value of the designed kit was 98%، compared with the foreign kits.

This kit has a diagnostic value in the assessment of hGH; therefore، it can be a good alternative to the commercial kits. Therefore، this antibody and ELISA kit can be produced more cost-effectively and can be a step towards self-sufficiency.

To evaluate all cases of drug induced angle closure glaucoma cases who presented to Feiz Hospital, Isfahan during 2008-2010.Case Report: In this retrospective case series, we present 7 cases of drug induced angle closure glaucoma after administration of Topiramate. All patients were female. The average age of patients was 33.28 years old (ranging from 19 to 44). With sufficient corneal clarity, mean BCVA was 20/400 and mean refractive error was -6.50 (rang -3.00 to-12.00) diopters. Mean intraocular pressure was 44.71 (rang 34 to 60) mmHg. Mean time normalization of intraocular pressure was 12.30 (rang 8 to 23) hours. Acute myopia and acute angle closure glaucoma are serious adverse effects of Topiramate, both of which are reversible with immediate discontinuation of the drug. So, taking a complete drug history and thinking about culprit drugs is critical in the evaluation of such cases.

To report a case of endogenous Klebsiella endophthalmitis associated with liver abscess in Iran.Case report: A 79 year old man was referred with chief complaint of left eye pain and visual loss. The patient had conjunctival hyperemia, corneal edema, hypopyon and severe vitreous cellular reaction in the left eye and yellowish conjunctival discoloration which was apparent in the right eye. Abdominal CT scan revealed a right liver lobe abscess that underwent percutaneous liver biopsy under sonography guide. Blood, vitreous and liver mass cultures revealed Klebsiella Pneumonia growth. The patient was diagnosed as a case of endogenous Klebsiella endophthalmitis secondary to bacteremia associated with liver abscess.

This report suggests that rather than being confined to Far East, endogenous endophthalmitis secondary to liver abscess due to Klebsiella pneumonia may be a global problem.

To evaluate refractive, visual, topographic, and wavefront outcome of photorefractive keratectomy (PRK) for treatment of myopia and myopic astigmatism with two different excimer laser systems: Technolas 217z and Lasersight LSX excimer lasers.

183 eyes of 95 patients enrolled in this clinical trial. Patients underwent PRK in a Sadra refractive surgery center with Technolas or Lasersight system by a single surgeon between 2007 and 2011. For PRK we used Technolas 217z in one group and Lasersight LSX excimer laser in another group. Subjects examined before and 24 months after surgery evaluating vision, refraction, Orbscan topography, and Wavefront analysis. Data collected, analyzed with SPSS 16. We used Student t-test for statistical data analysis.

83 eyes were in the Lasersight group and 100 eyes in the Technolas group. Pre-op spherical equivalent refraction was not different in two groops. After surgery it was -0.93 ± 0.73 in Technolas and -0.19 ± 0.40 in Lasersight group, the difference was statistically significant (P < 0.001). Post-op difference vector of astigmatic correction was 0.44 ± 0.58 in Technolas and 0.41 ± 0.26 diopters in Lasersight group (P = 0.04). Post-op LogMAR Acuity was 0.015 ± 0.027 in Technolas and 0.0005 ± 0.005 in Lasersight group (P < 0.001). Post-op Q value of asphericity was 0.24 ± 0.33 in Technolas and 0.46 ± 0.37 in Lasersight group (P < 0.001).

Post-op spherical equivalent refractive outcome, best corrected distance visual acuity and satisfaction were better in Lasersight group. We did not find any difference regarding post-op wavefront analysis between groups.

Photorefractive keratectomy or PRK is a good way to correct mild, moderate and severe myopia and astigmatism. Because of several reports about the sight threatening of Hyperopic PRK, it’s effectiveness is less known. This study was done to characterize the refractive changes after excimer laser PRK for correction of hyperopia > 3 diopters and to assess refractive state and changes in astigmatism after 1year.

In an interventional study, thirty eyes of nineteen patients were participated. Their mean refractive error was +5.45 diopters and mean astigmatism was -1.42D. All of the patients were treated by Technolas 217-z excimer laser. Post operative SE (sphere equivalent), UNCVA (uncorrected visual acuity), BCVA (best corrected visual acuity) and all of the complications examined at 12 months later.

The mean post operative refraction was +1.00D (range-2.00 to +5.00), the mean SE was 0.55D and mean astigmatism was -0.95D (range -0.25 to-2.00D). Mean BCVA was unchanged or improved in 83.4% of cases (pre op log MAR = 0.10 and post op log MAR = 0.11) but five eyes (16.6%) lost 1 or 2 lines of snellen BCVA. In 46.6% refraction was within +/-1.00D and 80% was within +/-2.00 from target refraction. The grade corneal haze in eighteen eyes (66%) was 0 or 0.5 and in one eye was 3 and neither developed to grade 4.

Hyperopic PRK has a low predictability for high hyperopia but it is effective for low hyperopia. We do not recomended PRK in highly hyperopic-astigmatic eyes.

Curriculum assessment is part of educational systems. In the absence of an assessment of present situations, any intervention would be futile. This study was done to determine achievement rate of medical students in advanced clerkship (externship) courses through using logbooks. This retrospective cross-sectional descriptive study was done on medical student's logbooks between June and December 2010 in Isfahan University of Medical Sciences. The students were passing their externship courses. Random sampling was done and 30 logbooks from departments of orthopedics, ENT, neurology, anesthesiology and toxicology, infectious diseases, and internal medicine were analyzed; descriptive statistics and SPSS were used for data analysis. 180 logbook tables were analyzed. Average number of skill performances supervised once or more were found to be: 8 (out of 10) skills in anesthesiology and toxicology, 5(out of 11) skills in infectios diseases,7(out of 20)skills in internal medicine, 8 (out of 13) skills in orthopedics, 11 (out of 11) in ENT, and 10 (out of 10) in neurology. Findings showed that actual skills achievement is far from ideal in the studied departments. Therefore, interventional measures such as involving residents in instruction, more practical instructions in CSLC, using instructional films,arranging hospital shifts for interns, applying OSCEs, etc. shoud be taken.

Various studies show that Log book can be also used in evaluation of medical course curriculum in clinical level in addition to evaluation of students’ achievement and their level of competencies. This article was to investigate the applicability of this new usage of Log book.

Logbooks were designed by faculty members through various sessions in clinical departments in six sections of introduction, outcomes and essentials of learning, disease exposure case reports, communication skills evaluation, procedural skills learning in the morning and at the time of shift. Logbooks were filled by students and returned.Then, frequency of observed cases by students and the fields used by the departments were calculated.

The students had not observed 5 diseases (26%) in orthopedic Dept., 6 diseases (50%) in neurology Dept., 15diseases (68%) in infectious diseases Dept. and 1 disease (6%) in toxicology Dept. But, all diseases had been observed in ENT Dept by students. Log books in Dept. of internal medicine were so incomplete that their data were not usable. Departments of orthopedics and neurology from outpatient clinics, Department of infectious diseases from hospitalization ward, Department of toxicology from emergency had the highest usage.

If students, faculty members and residents in educational departments know well about the importance and role of logbook and observe its function results, logbook can be used for evaluation of educational curriculum.

Controversy has recently risen about the presence of compensatory ocular countertorsion (COCT) after head tilt. This study was performed to define the functional range of this phenomenon. Cycloplegic autorefraction was performed on 80 eyes with regular astigmatism 2D. Objective autorefraction was performed in normal position, right and left head tilt positions of 5º, 10º, 15º, 20º, and 25º. Any change in astigmatic axis after head tilt was considered as COCT defect. The authors designed a tiltometer which was fixed over the patient's head without disturbing proper refractometry in various head positions. Enrolled eyes had no other ocular disease except refractive error. Seventy eyes completed the study process. Mean age of the patients was 26.5±10 (15-48) years. Mean amplitude of COCT was 1.87°±1.81 (0°-5°) at 5° and 6.91°±4.96 (0º-20°) at 25° head tilt angles. COCT values with left head tilt were significantly lower than COCT values with right head tilt (P<0.026). Incyclotorsional compensation in each eye was not necessarily equal to the excyclotorsional compensation of the fellow eye, but this torsional discrepancy was not overal significant (P>0.237). COCT was found to be an unreliable phenomenon. Any minimal head tilt can induce erroneous measurement of astigmatic axis during refractometry.

To compare post-operative pain with cooling photorefractive keratectomy (PRK) versus conventional PRK. A prospective clinical trial was performed on 94 eyes from 47 patients scheduled for PRK. Patients were randomly assigned to either cooling or conventional PRK. Pain was evaluated 6, 12, 24 and 48 hours post-operation using a visual analogue scale (VAS). Corneal haze, conjunctival and palpebral edema, and complications were also assessed. Mean age of the patients was 24.8±4.5 (range: 18-36 years) and mean refractive error was 3.6±1.6 diopters. Median pain score in the cooling group at 6 and 12 hours was 15 and 10, respectively and zero at 24 and 48 hours. Median pain score in the conventional group at 6 and 12 hours was 30 and 15 and was zero at 24 and 48 hours. There was no adverse effect in either of the groups. Cooling PRK effectively reduces post-operative pain after PRK without any additional adverse effect.

To determine the effect of intravitreal triamcinolone (IVT) injection on visual acuity in patients with ischemic central retinal occlusion (CRVO).

This randomized clinical trial was performed on patients with ischemic CRVO referred to the retina clinic at Feiz Hospital in 2007-2008. Inclusion criteria were: duration of CRVO less than one month, normal IOP, no sign of diabetic retinopathy or hypertensive retinopathy, no history of laser therapy and ocular surgery and vascular diseases. Patients were randomly allocated to two groups: intervention group (injection of 0.1cc IVT) and control group (no injection). Follow up examinations for all patients were scheduled 1, 2, 3 and 6 months after injection. The results were analyzed by SPSS13 and t-test.

Overall, 52 patients (22 male and 30 female) entered the study. Mean age was 60.5+9.7 (range: 30-80) years. Duration of signs was 21+5.5 days in the control group and 19+6 days in the IVT group (P= 0.66).All patients had signs of ischemic CRVO. Mean baseline visual acuity was 1.75+0.20 logMAR in the IVT group and 1.91+0.08 logMAR in the control group (P= 0.1). VA improvement in the IVT group was greater in comparison with the control group at one month (P= 0.019) however this difference was not significant at other follow-up examinations. In addition, the difference in IOP between before and after the injection was not significant (P= 0.802).

This study showed that in patients with CRVO, intravitreal injection of triamcinolone, has no significant long-term effect on visual acuity.

To compare intraocular pressure (IOP) measurement with Pulsair non-contact tonometer and Goldmann applanation tonometer (GAT).

In this cross-sectional study, during a complete ophthalmologic examination, each patient underwent Pulsair tonometry three times at 5 minutes intervals and then Goldmann tonometry at the same intervals. Mean IOP values were measured and analyzed.

We evaluated 458 eyes of 250 patients (138 males and 112 female subjects). Mean IOP was 19.45±9.04 mmHg with GAT and 20.11±8.42 mmHg with Pulsair (P=0.075). Correlation coefficient between the two methods was 0.96 (P= 0.004) and the mean difference (Pulsair-GAT) was 0.65±1.52 (confidence interval 95%, +3.5 to -2.29). With IOPs between 10-25mmHg, mean difference between the two methods was 0.49±1.23 (P= 0.32) mmHg, however it was -1.75±1.91 (P= 0.06) at IOPs over than 25 mm Hg.

Pulsair tonometry has acceptable accuracy in comparison with GAT, especially in IOP ranging from 10 to 25 mmHg

To compare the effects of standard tissue saving method and personalized techniques of photorefractive keratectomy (PRK) on aberration changes in fellow eyes.

This randomized controlled trial was performed on patients who were referred to Isfahan Parsian Clinic during 2007. After a comprehensive ophthalmologic examination, PRK was randomly performed using tissue saving (TS) technique in one eye and personalized (P) technique in the fellow eye. Aberrometry was performed pre- and 6 months postoperatively.

This study included 296 eyes of 148 (67 male and 81 female) patients with mean age of 29.1±7.0 years. The two groups had no significant difference in terms of laterality, pupil size and level of myopia preoperatively (P=0.65). Uncorrected visual acuity was 20/25 or more in 88.9% of the TS group and 92.6% of the P group (P=0.83). Mean refractive error 6 months postoperatively was -0.50±0.36 diopter (D) in the TS group and 0.31±0.43 D in the P group (P=0.95). Mean root-mean-square (RMS) value was -0.41±0.17 preoperatively and 0.86±0.43 postoperatively in the group TS (P<0.01). Corresponding figures were 0.47±0.39 and 0.77±0.43 in the P group (P<0.01). The two groups did not differ regarding pre- and postoperative RMS.

Postoperative aberrations may be increased with both tissues saving and personalized techniques of PRK with no significant difference between them in this regard.