Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 06 208 214 EN Sukanya Sudhaharan Nizam's Institute of Medical Sciences Panjagutta, Hyderabad, Telangana, India Padmaja Kanne Nizam's Institute of Medical Sciences Panjagutta, Hyderabad, Telangana, India Lakshmi Vemu Nizam's Institute of Medical Sciences Panjagutta, Hyderabad, Telangana, India Padmasri Chavali Nizam's Institute of Medical Sciences Panjagutta, Hyderabad, Telangana, India Shanker Rao Desmukha Nizam's Institute of Medical Sciences Panjagutta, Hyderabad, Telangana, India Bheerappa Nagari Nizam's Institute of Medical Sciences Panjagutta, Hyderabad, Telangana, India 2018 01 29 2018 08 16 Background and Objectives: Intra-abdominal infections (IAIs) include a wide spectrum of pathological conditions, ranging from uncomplicated appendicitis to fecal peritonitis .The resulting infections should be diagnosed early and treated based on the organism isolated and its susceptibility. In this study the bacteriological profile and antimicrobial resistance pattern of intra-abdominal infections was analyzed. Materials and Methods: A retrospective analysis of samples received from 119 cases of intra-abdominal infections in our Institute from January 2015 to December 2017 was analyzed. Patients with primary peritonitis from cirrhosis or ascites were not included in the study. The specimens were primarily processed, as per standard methods. Identification and antimicrobial susceptibility testing was done by the Vitek-2 system. Anaerobic culture was performed on 5% sheep blood agar plates and incubated in GEN bag anaerobic pouches. Results: In our study perforative peritonitis 43/119 (36.1%) was predominant IAI followed by acute pancreatitis 14/119 (11.7%) and pancreatic necrosis 12/119 (10%). Microbial growth was observed in 66.3% (79/119) of the cases and combined infections were observed in14/119 (11.7%) of the cases. Escherichia coli was the predominant organism isolated in 58/119 (40.8%), out of which 41/58 (70.6%) were ESBL producers and 16 /58 (27.5%) were multi drug resistant isolates. Klebsiella pneumoniae was isolated from 11/119 (9.2%) cases out of which 8/11 (72.7%) were ESBL and 3/11 (27.2%) were multidrug resistant isolates. Post-operative complications was observed in 12/119 (10%) patients with mortality in 15/119 (12.6%) patients. Conclusion: Early diagnosis and appropriate management of the infections will help to prevent the morbidity and mortality associated with these infections. https://ijm.tums.ac.ir/index.php/ijm/article/view/1638 https://ijm.tums.ac.ir/index.php/ijm/article/download/1638/1060

Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 06 250 253 EN Mahdi Rohani Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran AND National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran Behzad Mohsenpour Zoonosis Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran Ahmad Ghasemi National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran AND Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Saber Esmaeili National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran AND Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran Mohammad Karimi Centre for Communicable Diseases Control, Deputy of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran Heinrich Neubauer Federal Research Institute for Animal Health, Friedrich-Loeffler-Institut, Jena, Germany Herbert Tomaso Federal Research Institute for Animal Health, Friedrich-Loeffler-Institut, Jena, Germany Ehsan Mostafavi National Reference Laboratory for Plague, Tularemia and Q Fever, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran AND Department of Epidemiology and Biostatistics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Tehran, Iran 2018 07 20 2018 10 06 Tularemia is one of the most contagious bacterial infections. Here, we report a human case of glandular tularemia in Iran following the first report in 1980. The patient was a 6-year-old girl who had consumed a hunted hare in Kurdistan Province in western Iran. https://ijm.tums.ac.ir/index.php/ijm/article/view/1826 https://ijm.tums.ac.ir/index.php/ijm/article/download/1826/1056

Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 06 215 219 EN Ashkan Faridi Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran Amir Tavakoli Kareshk Infectious Diseases Reesearch Center, Birjand University of Medical Sciences, Birjand, Iran Mehdi Fatahi-Bafghi Department of Microbiology, Faculty of Medicine, Shahid Sadoughi University of Medical Sciences Yazd, Iran Mahsa Ziasistani Pathology and Stem Cell Research Center, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran Mohammad Reza Kandehkar Ghahraman Student Research Committee, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran Seyedeh Zeinab Seyyed-Yousefi Department of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Noshin Shakeri Shahid Labafi Nejad Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran Davood Kalantar-Neyestanaki Department of Microbiology and Virology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran 2017 12 10 2018 06 06 Background and Objectives: Staphylococcus aureus is the main Gram-positive bacteria isolated from patients with ocular infections. Herein, we describe the pattern of antibiotic resistance, presence of resistance genes including ermA, ermB, ermC, msrA, mecA and the pvl cytotoxin gene in S. aureus isolates collected from patients with external ocular infection. Materials and Methods: In this study, 8 S. aureus isolates were collected from 81 patients that suffered from eye damage. Antibacterial susceptibility of isolates was determined using the Kirby-Bauer disk diffusion method. Resistance genes including ermA, ermB, ermC, msrA, mecA and the pvl virulence gene were detected by PCR method. Staphylococcal cassette chromosome mec (SCCmec) in MRSA isolates were detected by the multiplex-PCR method. Results: Three isolates were resistant to cefoxitin which is considered MRSA. The mecA gene was identified in MRSA isolates. SCCmec type IV and the pvl gene were detected in one of the MRSA isolates that was recovered from a diabetic patient. Conclusion: The emergence of S. aureus isolates belonging to SCCmec type IV and pvl gene among patients with ocular infection is very serious; therefore, identify genetic characterization of MRSA isolates for empirical therapy and infection control is very important. https://ijm.tums.ac.ir/index.php/ijm/article/view/1579 https://ijm.tums.ac.ir/index.php/ijm/article/download/1579/1061

Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 06 220 226 EN Fargol Abdali Nutrition Research Center, Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Saeid Hosseinzadeh Department of Food Hygiene and Public Health, School of Veterinary Medicine, Shiraz University, Shiraz, Iran Enayat Berizi Nutrition Research Center, Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Siamak Shams Department of Environmental Health Ward, Shiraz University of Medical Sciences, Shiraz, Iran 2018 04 19 2018 09 15 Background and objectives: Q fever is a worldwide disease which is common between human and livestock. This disease is created by an obligate intracellular Rickettsia called Coxiella burnetii (C. burnetii). Cattle, goats and sheep are among the main reservoirs of the disease in humans. The most common routs of transmitting the infection to humans are inhalation of contaminated aerosols and drinking milk and non-pasteurized dairy products. This study was aimed to determine the prevalence of C. burnetii in non-pasteurized dairy products in Shiraz. Materials and Methods: In this study (from summer 2016 to winter 2016), 238 non-pasteurized dairy products, (48 raw milk, 48 yogurt, 46 cheeses, 48 dough and 48 ice cream samples) were collected from the retail market and analyzed using a nested PCR assay. Results: This study showed that 20 samples (8.4%) of 238 non-pasteurized dairy products were reported positive for C. burnetii (13 of 48 (27.08%) raw milk, 3 of 48 (6.25%) yogurt, 2 of 46 (4.35%) cheese, 2 of 48 (4.16%) dough and 0 of 48 ice cream samples). Conclusions: The present study suggests that non-pasteurized dairy as main sources of C. burnetii in Shiraz, Southern Iran; thus, the consumption of pasteurized milk and dairy products is a valuable method to prevent the disease in human. https://ijm.tums.ac.ir/index.php/ijm/article/view/1715 https://ijm.tums.ac.ir/index.php/ijm/article/download/1715/1052

Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 06 227 232 EN Arun Sachu Department of Microbiology, Government TD Medical College, Alappuzha, Kerala, India Anitha Madhavan Department of Microbiology, Government TD Medical College, Alappuzha, Kerala, India Anu Vasudevan Department of Biostatistics, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India Jayalakshmi Vasudevapanicker Department of Microbiology, Government TD Medical College, Alappuzha, Kerala, India 2018 05 11 2018 09 07 Background and Objectives: Dengue and Leptospirosis were often discussed separately with rash being more common in dengue and jaundice in leptospirosis. But with increasing reports of co-infection, the situation has become worse. The main objective of this study was to look for the presence of both Dengue and Leptospira IgM antibodies in serum samples of patients, presenting with acute febrile illness. Medical records of the co-infected patients were examined to analyse the clinical features and laboratory findings. Materials and Methods: Serum samples of patients presenting with acute febrile illness were screened for the presence of Dengue IgM antibodies and Leptospira antibodies. Clinical features and laboratory parameters of patients with co-infection were compared with patients having dengue alone. Rainfall data was obtained to look for an association between rainfall and Dengue, leptospirosis and co-infected cases. Results: Co-infection was seen in 33 (3.4%) samples. There was a statistically significant association between clinical features like rashes, bleeding gums and co-infection. There was a statistically significant association between various laboratory parameters like thrombocytopenia and co-infection. There was positive correlation between rainfall and development of dengue, leptospirosis, and co-infection but it was not statistically significant. Conclusion: The overall prevalence of co-infection was 3.4%. This study re-emphasizes the fact that dengue and leptospirosis are widely prevalent in south India and clinicians should be aware that co-infection with dengue and leptospirosis is not uncommon. https://ijm.tums.ac.ir/index.php/ijm/article/view/1734 https://ijm.tums.ac.ir/index.php/ijm/article/download/1734/1049 https://ijm.tums.ac.ir/index.php/ijm/article/download/1734/1053

Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 06 233 241 EN Mohammad Amin Behzadi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Mohammad Ali Davarpanah HIV Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Mandana Namayandeh Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Bahman Pourabbas Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Soheyla Allahyari HIV Research Center, Shiraz University of Medical Sciences, Shiraz, Iran Mazyar Ziyaeyan Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran 2017 10 04 2018 08 04 Background and Objectives: Human immunodeficiency virus (HIV)-infected women are usually at a higher risk of sexually transmitted infections (STIs) than others. The objective of this study was to characterize the prevalence of human papilloma virus (HPV), herpes simplex virus (HSV), Chlamydia trachomatis (CT), and Neisseria gonorrhoeae (NG), and associated risk factors among HIV-infected women in Fars province, Iran. Materials and Methods: In this cross-sectional study, cervical swab samples were collected from 71 HIV-infected women, aged 17-45 years (mean ± standard deviation: 31.11 ± 6.58 years), and tested for HPV, HSV, CT, and NG using PCR assays. Results: Overall, 77.5% of patients were positive for the tested STIs with the following distribution: 36 (50.7%) HPV, 7 (9.9%) HSV, 4 (5.6%) NG, and 27 (38%) CT. From those, 39 (55%) were positive for only one infection, while 16 (22.5%) were positive for multiple infections. We observed that the prevalence of all tested STIs increased by age, except for HSV which showed a slight decrease, although not statistically significant. Socio-economic factors such as low educational level, multiple sex partners, and being a sex worker significantly correlated with higher positive prevalence of STIs in the studied population. Conclusion: A high prevalence of STIs was observed among HIV-infected women in this region. These data might prompt policy makers and STI experts to focus on providing a comprehensive sex education, including participation in screening programs for STIs among high-risk groups. https://ijm.tums.ac.ir/index.php/ijm/article/view/1516 https://ijm.tums.ac.ir/index.php/ijm/article/download/1516/1054

Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 06 242 249 EN Rosetta Moshirian Farahi Department of Microbiology, Alzahra University, Tehran, Iran Ahya Abdi Ali Department of Microbiology, Alzahra University, Tehran, Iran Sara Gharavi Department of Biotechnology, Alzahra University, Tehran, Iran 2018 03 14 2018 08 05 Background and Objectives: Pseudomonas aeruginosa, a major cause of several infectious diseases, has become a hazardous resistant pathogen. One of the factors contributing to quinolone resistance in P. aeruginosa is mutations occurring in gyrA and parC genes encoding the A subunits of type II and IV topoisomerases, respectively, in quinolone resistance determining regions (QRDR) of the bacterial chromosome. Materials and Methods: Thirty seven isolates from patients with burn wounds and 20 isolates from blood, urine and sputum specimen were collected. Minimum Inhibitory Concentrations (MICs) of ciprofloxacin were determined by agar diffusion assay. Subsequently, QRDRs regions of gyrA and parC were amplified from resistant isolates and were assessed for mutations involved in ciprofloxacin resistance after sequencing. Results: Nine isolates with MIC≥8 µg/ml had a mutation in gyrA (Thr83→Ile). Amongst these, seven isolates also had a mutation in parC (Ser87→ Leu or Trp) indicating that the prevalent mutation in gyrA is Thr83Ile and Ser87Leu/Trp in parC. No single parC mutation was observed. Conclusion: It seems that mutations in gyrA are concomitant with mutations in parC which might lead to high-level ciprofloxacin resistance in P. aeruginosa isolates from patients with burn wounds and urinary tract infections. https://ijm.tums.ac.ir/index.php/ijm/article/view/1679 https://ijm.tums.ac.ir/index.php/ijm/article/download/1679/1062

Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 06 254 257 EN Leila Rahimvand Faculty of Dentistry, Shahed University, Tehran, Iran Mohammad Niakan Department of Microbiology, Faculty of Medicine, Shahed University, Tehran, Iran Noushin Jalayer Naderi Department of Oral and Maxillofacial Pathology, Faculty of Dentistry, Shahed University, Tehran, Iran 2017 10 27 2018 08 02 Background and Objectives: Anaerobic Gram negative bacteria are the main cause of periodontal destruction. It has been shown that Myrtus communis have anti-bacterial activity on Gram positive and Gram negative bacteria. The aim of this study was to determine the antibacterial effect of aquatic and methanolic extract of Myrtus communis on some of the oral Gram-negative bacteria. Materials and Methods: The antibacterial effect of aquatic and methanolic extracts of Myrtus communis was determined using disk diffusion method at different concentrations from 10 to 500 mg/ml. The diameter of inhibition zones were determined. The MIC was defined using the standard broth macrodilution method. The results of the study were reported descriptively. Results: The aquatic extract of Myrtus communis from 20 to 500 mg/ml had antibacterial effect on Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis and Prevotella intermedia. The methanolic extract from 10 to 500 mg/ml had antibacterial effect on A. actinomycetemcomitans, P. gingivalis and P. intermediate. The MIC was achieved at 10 mg/ml, 10 mg/ml and 10 mg/ml for aquatic and methanolic extracts of Myrtus communis on A. Actinomycetemcomitans, P. Gingivalis and P. Intermediate, respectively. Conclusion: Aquatic and methanolic extracts of Myrtus communis had antibacterial effect on P. gingivalis, A. actinomycetemcomitans and P. intermediate. Most concentrations of aqueous extract were effective on bacteria, so, providing an alcoholic extract, that is a time consuming and costly method, does not seem necessary. https://ijm.tums.ac.ir/index.php/ijm/article/view/1529 https://ijm.tums.ac.ir/index.php/ijm/article/download/1529/1063

Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 06 258 265 EN Abdolnabi Shabani Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz JundiShapur University of Medical Sciences, Ahvaz, Iran Manoochehr Makvandi Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz JundiShapur University of Medical Sciences, Ahvaz, Iran Alireza Samarbafzadeh Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz JundiShapur University of Medical Sciences, Ahvaz, Iran Ali Teimoori Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz JundiShapur University of Medical Sciences, Ahvaz, Iran Mojtaba Rasti Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz JundiShapur University of Medical Sciences, Ahvaz, Iran Chiman Karami Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz JundiShapur University of Medical Sciences, Ahvaz, Iran Nasteran Rastegarvand Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz JundiShapur University of Medical Sciences, Ahvaz, Iran AND Department Infectious, Abozar Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Roya Nikfar Infectious and Tropical Diseases Research Center, Health Research Institute, Ahvaz JundiShapur University of Medical Sciences, Ahvaz, Iran Ahmad Shamsizadeh Department Infectious, Abozar Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Azam Salehi Parasitology Department, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Kambiz Ahmadi Angali Biostatistic Department, School of Health, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran 2017 09 04 2018 06 25 Background and Objectives: Human enteroviruses (EV) are the most common causes of neonatal sepsis-like disease. The frequencies of EV including coxsackievirus A, coxsackievirus B and Echovirus serotypes have been studied in young infants (younger than three months) with sepsis. So far, the role of enteroviruses among neonates with sepsis was not determined in Ahvaz, Iran. Therefore, this study was aimed to evaluate the frequency of EV among hospitalized young infants with clinical signs and symptoms of sepsis in Ahvaz. Materials and Methods: Blood specimens from 128 neonates (younger than 90 days), including 56 (43.75%) girls and 72 (56.25%) boys, were collected from hospitalized neonates with clinical signs and symptoms of sepsis-like symptoms. All blood samples were negative for bacterial culture. RNA was extracted from all sera and tested for detection of 5'UTR (Untranslated Region) of the EV by RT-PCR. To determine specific strains of EV, positive 5ˊUTR samples were further tested for detection of the VP1 region of EV by RT-PCR. Results: Overall, 50/128 (39.06%) specimens, including 24 (48%) girls and 26 (52%) boys, were positive for EV. 21/ 50 (42%) specimens were positive for the VP1 region. Randomly, 8 positive VP1 were selected and sequenced. Analysis of sequencing data showed 7/21 (33.33%) samples were positive for Echovirus 30 and 1/21 (4.76%) samples were positive for CVA9. Conclusion: The results of this survey indicate high prevalence of 39.06% of EV among young neonates with sepsis. A high prevalence of 33.3% Echoviruses 30 and a low rate of 4.76% coxsackievirus A9 infection has been observed in neonatal patients with viral sepsis. This outbreak is probably one of the first Enterovirus outbreaks to be reported in Ahvaz, Iran. The results of this survey will help to minimize unneeded use of antimicrobial drugs and reduce unnecessary hospitalization. https://ijm.tums.ac.ir/index.php/ijm/article/view/1497 https://ijm.tums.ac.ir/index.php/ijm/article/download/1497/1064

Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 10 4 2018 10 07 266 274 EN Samira Izi Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Masoud Youssefi Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran AND Antimicrobial Resistance Research Center, Mashhad University of Medical Sciences, Mashhad, Iran Farzad Rahmani Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Nema Mohammadian Roshan Department of Pathology, Ghaem Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Atefeh Yari Department of Microbiology and Virology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran Farnaz Zahedi Avval Department of Clinical Biochemistry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran AND Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran 2018 03 18 2018 05 13 Background and Objectives: Factors contributing to development of gastric cancer are still under investigation. The JC Virus (JCV), as an oncogenic virus, has been indicated to play a possible role in gastric carcinogenesis. Theoretically, tumor antigen (T-Ag), the viral transforming protein, is capable of binding and inactivating tumor suppressor proteins p53 and pRb, there by promoting cancer development although such a role in gastric cancer is still controversial and additional data is needed to reach a definite conclusion. The prevalence of the virus varies in different geographic regions, therefore, we aimed to investigate JCV presence in cancerous gastric tissues of Iranian patients. Materials and Methods: Thirty-one paired samples were included in this study (total of 62 samples). T-Ag sequences were investigated using real-time PCR in formalin fixed paraffin embedded (FFPE) tissue samples from the tumor site and relevant adjacent non-cancerous tissues (ANCT). In positive samples, JCV copy number (viral load) was also measured using real-time PCR. To evaluate T-Ag protein expression, immunohistochemistry examination was performed using an anti-T-Ag specific antibody. Results: JCV sequences were detected in 17 out of 31 gastric cancer tissue samples (54.84%) and in 10 out of 31 of the non-cancerous adjacent gastric mucosa (32.25%) (Odds ratio of 2.4). Viral load in tumoral and adjacent tissue samples was not statistically different (p=0.88). Immunohistochemical study confirmed presence of JC T-Ag in the nuclear compartment. Conclusion: We showed the presence of the JC virus in gastric carcinoma tissue samples in our geographic region. This finding provides supportive data for a possible contribution of JCV in gastric cell transformation to malignancy. However, we highly recommend additional investigations to further explore JC virus and gastric cancer in order to reach a conclusion. https://ijm.tums.ac.ir/index.php/ijm/article/view/1688 https://ijm.tums.ac.ir/index.php/ijm/article/download/1688/1065