JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2020 | Volume:30 | Issue:189|Papers Count:20

Background and purpose: Intravenous (IV) catheterization is one of the common painful procedures in children. This study aimed to investigate the effect of cold and warm vibration on pain caused by IV catheterization in 3-to 6-year-old children using a buzzy device. Materials and methods: A randomized clinical trial was carried out in 108 children in Mashhad Akbar Pediatric Hospital selected via random blocking. They were divided into three groups to receive warm vibration, cold vibration, or vibration only (control group). In this study, a musical vibrating device in a form of bee with either a warm or cold pack was attached for 5 min at approximately 5-10 cm above the intravenous continuous infusion (IVCI) site. In last minute, vibration was applied, then, IV catheterization was done. The Wong-Baker FACES Pain Rating Scale (WBS) was used to rate pain severity. Data were analyzed in SPSS V19 at a significance level of 95%. Results: Before the intervention, there were no significant differences in mean pain score between the three groups (P>0. 05). Pain score was significantly different during the procedure (P<0. 05). Significant difference was seen in pain score between the two intervention groups (P<0. 05). The pain score was found to be significantly different between the intervention group that received cold vibration and the control group (P<0. 05), but, the score was not significantly different between the group with warm vibration and the control group (P>0. 05). Conclusion: Both cold and warm vibrations could reduce the pain caused by injection, but cold vibration showed greater effect on reducing pain. Therefore, cold or warm vibrating devices are suggested in management of aggressive painful procedures in children.

Background and purpose: The recent Coronavirus (SARS-CoV-2) has resulted in a sudden outbreak which has significantly affected various aspects of daily lives. This study was carried out to determine self-care barriers in prevention of Covid-19 according to healthcare experts and laypersons. Materials and methods: A qualitative-quantitative based cross-sectional research was designed. To perform the qualitative phase, group discussion with faculty members and managers in Isfahan University of Medical Sciences and phone interviews with laypersons were carried out. Then, data extracted in this phase were used to design a 40-item questionnaire which was found to be reliable (Cronbach’ s Alpha: 0. 90), to be completed by Iranian citizens in four days via social networks. In this survey, 1056 people participated. Data analysis was done in SPSS V21. Results: Self-care barriers according to the qualitative phase of the study included social barriers, psychological barriers, religious barriers, political and management barriers, healthcare system barriers, and information barriers. Political and management barriers (mean score=78. 87) and psychological barriers (belief, behavior, personality) (mean score=70. 01) were found to be the major self-care barriers. The mean self-care score was 8. 5 (in a scale of 0 to 10). The mean self-care scores were significantly higher in women (P<0. 0001) and in people with higher levels of education (P=0. 007). No significant difference was observed in mean self-care score based on marital status (P=0. 61) and occupation (P=0. 052). Conclusion: Health care managers and policymakers could guide people towards more efficient self-care by planning to reduce and overcome barriers identified in this study.

Background and purpose: Research is one of the significant foundations of community development, which requires understanding the capabilities, weaknesses and strengths of programs. This study aimed at investigating the motivations and barri ers to research in clinical faculty members. Materials and methods: This descriptive-analytical study was conducted in clinical faculty members (surgeon and non-surgeon) in Mazandaran University of Medical Sciences using census sampling. Data were collected via Research Barriers Questionnaire (Sotodeh Asl et al. ) and Research Motivation Scale (Salehi). Data analysis was done applying Mann-Whitney test and Kruskal-Wallis test. Results: One hundred thirty-nine individuals aged 40-50 years participated in this study and the participation rate was high (81%). The motivation for research activities was higher in females (59. 92 ± 6. 38) than males (57. 24 ± 5. 47) (P< 0. 05). Major obstacles to preparation and compiling a research project, in both surgeon and non-surgeon groups, were lack of clear research needs (3. 68 ± 0. 67) and priorities (3. 11 ± 0. 89) in the university. In project implementation, lack of appropriate space (3. 50 ± 1. 04) was reported as the main problem by both groups. In administrative and management context, little attention to creativity (3. 80 ± 0. 86) and financial and budget problems (3. 27 ± 1. 21) were the main barriers according to both surgeon and non-surgeon faculty members, respectively (P> 0. 05). Conclusion: Despite sufficient motivation, organizational and individual barriers affect research activities. These obstacles could be removed by clarifying research priorities, creating a suitable physical space, and solving financial problems.

Background and purpose: Diazinon is an organophosphate insecticide that binds to the acetylcholinesterase enzyme after metabolization causing its inactivation. Galic acid is a polyphenolic compound with nucleophilic properties. The aim of this study was to investigate the effects of gallic acid on reactivation of acetylcholine and butyrylcholinesterase inhibited by diazinon in mice and human serum and erythrocytes. Materials and methods: The animals were divided into seven groups, including a control group that received corn oil as a solvent and other groups that received diazinon (80 mg/kg), atropine (20 mg/kg), and pralidoxime (20 mg/kg). Gallic acid was injected intraperitoneally at 50, 100, and 200 mg/kg. Cholinesterase levels (acetylcholine and butyrylcholinesterase) were evaluated after 3 and 24 h of intoxication in mice serum and erythrocytes. In addition, in vitro studies were done in human serum and RBCs. Results: Activities of cholinesterase in serum and erythrocytes significantly decreased after 3 and 24 hours of poisoning in diazinon-treated group compared to control group in vivo and in vitro. Co-treatment with atropine and gallic acid (at all doses) significantly increased cholinesterase activity compared to the diazinon group in vitro and in vivo (P< 0. 0001). Conclusion: Combination therapy with gallic acid (at different doses) and atropine reduced inhibition of cholinesterase activity caused by diazinon and improved its reactivation. Gallic acid reactivates cholinesterase activity which might be due to hydroxyl groups in its compounds.

Background and purpose: Insecticide resistance in mosquitoes particularly malaia may lead to reemergence of malaria epidemics. This study aimed to investigate the effect of oral and intramuscular administration of ivermectin on guinea pigs exposed to Anopheles stephensi mosquitoes, the main malaria vector. Materials and methods: The effect of ivermectin was studied in oral and intramuscular administrations (treatment groups), and untreated (control group), on guinea pigs exposed to 750 Anopheles stephensi mosquitoes. The experiments were done at larval, hatching eggs and pregnancy stages in insectary condition at the School of Public Health, Tehran University of Medical Sciences, 2018. Results: After 24-hours of blood feeding, the mortality rates of An. stephensi were 74. 19% and 66. 4% in animals with intramuscular and oral administration of ivermectin, respectively, which were significantly different with that of the control group (2. 80%) (P< 0. 001). The rates of infertility in two experimental groups were 63. 63% and 45. 23%, respectively and in control group it was 19. 42% (P< 0. 001). Infertility was found to be significantly different between the experimental groups and the control group (P<0. 001). Conclusion: According to this study, ivermectin was effective in decreasing the survival of Anopheles stephensi. therefore, it is suggested to be evaluated in field conditions.

Background and purpose: Chronic stress has detrimental effects on reproductive system. Offspring are likely to be vulnerable to adverse effects from antipsychotic medication and stress transmitted through gonads and gametes. The present study aimed to investigate the fertility of female rats from male rats treated with sulpiride because of chronic physical or psychological stress. Materials and methods: In this experimental study, 36 adult male Wistar rats weighing 190± 10 g were divided into six groups: control, sulpiride (the antagonist of dopamine D2 receptors) (4mg/kg, bw, ip), physical or psychological stress, and physical or psychological stress that received sulpiride. After 14 days, each male rat mated with three adult female rats. The female offspring of these rats were raised in normal conditions until adulthood. Then, the ovaries and body weight, and fertility of offspring were assessed using IVF. Results: The weight of the body and ovaries, percentage of egg cells, bicellular embryos, blastocysts, and hatched embryos after IVF, significantly reduced in offspring of stressed male rats compared with control group (P<0. 05). Administration of sulpiride in male rats caused further reduction of these indices in IVF results of their female offspring (P<0. 05). The percentage of arrested embryos did not differ significantly between the stress groups (P>0. 05), but administration of sulpiride significantly increased that in all groups compared with saline groups (P<0. 05). Conclusion: Physical or psychological stress in parents reduced the fertility of female offspring and administration of sulpiride to parents exacerbated these disorders in offspring.

Background and purpose: Constipation is one of the most prevalent digestive problems in hemodialysis patients that threatens their life due to hyperkalemia. Acupressure could be helpful in this condition. This study aimed at investigating the effect of auriculotherapy on severity of constipation in patients undergoing hemodialysis. Materials and methods: A single-blind clinical trial was conducted in hemodialysis patients (n=70) experiencing constipation in Isfahan, Iran 2017. The samples were randomly assigned into either an intervention group or a control group. The intervention group underwent auriculotherapy using vaccaria seeds in five points for one month. Data were collected using Constipation Assessment Scale before, immediately after, and one month after the intervention and analyzed in SPSS V18 applying independent t-test, repeated measures ANOVA, analysis of covariance, and Chi-square test. Results: Significant differences were seen in severity of constipation between the intervention group and control group at all times (P<0. 05). Also, the mean decrease in the score for constipation severity in intervention group was significantly higher immediately after and one month after the intervention than the control group (P<0. 05). Conclusion: Auriculotherapy in constipation points; rectum, large intestine, shenmen, and kidney reduces the severity of constipation in hemodialysis patients. This method is recommended to reduce constipation severity in these patients.

Background and purpose: Airway assessment is very important in anesthesia. The aim of this study was to determine the diagnostic value of Mallampati test indicators in supine and sitting positions with and without phonation in anesthesia candidate patients. Materials and methods: This cross-sectional descriptive study (diagnostic approach) was done in 200 adult patients ≥ 16 years, undergoing surgery in hospitals affiliated with Mazandaran University of Medical Sciences, 2018-2019. Diagnostic indicators of Mallampati test, including accuracy, sensitivity, specificity, and positive and negative predictive values, in sitting and supine positions with and without phonation were determined before induction of anesthesia. Correlation between different Mallampati test methods was determined applying standard Cormac Lehane test. Results: Based on Cormack-lehane scoring, laryngoscopy was very difficult in 5. 5% (n=11) and difficult in 12% (n= 24), respectively. The correlation coefficients between Cormack Lehane test and Mallampati test in sitting and supine positions with phonation were 0. 332 and 0. 284, respectively. The highest sensitivity (82. 9%) and specificity (80%) were found in supine position without phonation and sitting position with phonation, respectively. In supine position with phonation, the sensitivity and specificity were 65. 7 % and 67. 9%, respectively. The accuracy of the sitting position with phonation was 77. 4%. Conclusion: The highest correlation between Malapmati test and Cormac Lehane test was in sitting position with phonation. Also, Malapmati test in supine position with phonation, has high sensitivity and specificity and is recommended as a suitable alternative for airway assessment.

Background and purpose: Health inspectors are faced with high levels of workload and stress. There is lack of evidence on the relationship between job burnout and the quality of working life in this group. So, research on this issue is highly needed. Materials and methods: This cross-sectional descriptive-analytical study was conducted on census based population (n=245 health inspectors) in Golestan University of Medical Sciences. Demographic information were collected and the Quality of Work Life (QWL) scale and Maslach Burnout Inventory (MBI) were also used. Data analysis was done in SPSS V18 applying Pearson's correlation coefficient and backward LR logistics regression to investigate the relationship between the quality of work life and job burnout and predicting the factors affecting job burnout, respectively. Results: Total QWL score and MBI score were 70. 40± 13. 42 and 42. 64± 20. 24, respectively. According to Pearson's correlation coefficient, there were significant inverse correlations between all dimensions of QWL and job burnout (P<0. 05). According to logistics regression, increase in QWL scores, from low to medium level, could 11 times reduce burnout (OR = 11. 143, 95%CI: 1. 32-93. 69). Conclusion: Based on current study, one of the intervention programs to reduce job burnout syndrome in health inspectors is focusing on factors that improve their quality of work life.

Background and purpose: So far, different methods have been used to remove residual antibiotics from aquatic environments. This study investigated the efficiency of enzyme horseradish peroxidase (HRP) in presence of hydrogen peroxide in removal of Tetracycline and Ciprofloxacin in a batch system. Materials and methods: In an experimental study on laboratory scale, the effects of contact time, concentrations of H2O2, the antibiotics, and enzyme, and reaction pH on the performance of pure HRP enzyme in the presence of H2O2, were investigated. To measure the efficiency of the enzymatic process, the residual antibiotics were measured using HPLC equipped with a reverse phase column (C-18, 5% micrometer, 250 * 4. 6 mm). The flow rate was 1 ml/min and the injection volume was 40 μ l. The mobile phase of Tetracycline was 0. 1 M TFA-methanol (60: 40) used at 254 nm and the mobile phase of ciprofloxacin was 0. 01 M acetonitrile-phosphate (8: 92) at 220 nm. All experiments were performed in a discontinuous system at laboratory temperature. Results: Removal efficiencies of Tetracycline and Ciprofloxacin were 40% and 95%, respectively, at 10 mg/l initial concentrations of antibiotics, 10-min contact time, Tetracycline pH= 4, and Ciprofloxacin pH= 7. The removal efficiency of Ciprofloxacin was two times more than that of Tetracycline. Conclusion: The free HRP could be used as an effective process in removing Tetracycline and Ciprofloxacin from wastewater.

Background and purpose: Water treatment is of great importance in human life, due to the contamination of water resources. Therefore, continuous evaluation of the performance of water treatment plants is necessary to minimize contamination within the treatment plant in order to create optimal conditions. Materials and methods: A cross-sectional descriptive analytic study was performed in Tehranpars water treatment plant. Water samples were collected at different stages (Pre-chlorination, Pulsator, Filtration and Post-chlorination) during 30 months. The samples were randomly taken one day per week and pH, water temperature, turbidity, dissolved organic carbon (DOC), and chlorophyll a contents were measured. Results: Average turbidity removal in pre-chlorination, pulsator, filtration, and final chlorination units were approximately (9%± 1. 74), (39%± 0. 77), (44% ± 0. 23), and (4%± 0. 1. 74), respectively and the overall efficiency of the treatment plant was 96%. The mean concentrations of DOC in effluent of Tehranpars water treatment plant were 2. 37± 0. 16, 2. 94± 0. 32, 1. 74± 0. 07, and 2. 17± 0. 16 mg/L in spring, summer, fall, and winter, respectively. Mean DOC values were higher than limits (2 mg/L) in all seasons except fall. Chlorophyll a concentrations in water entering the treatment plant were higher in summer and spring than other two seasons. Conclusion: Tehranpars water treatment plant showed considerable efficiency in reducing water turbidity. Pre-chlorination and final chlorination processes had the greatest effect on minimizing DOC concentration due to the high affinity of organic compounds with chlorine and formation of disinfectant by-products. Therefore, pre-ozonation is recommended as a solution to reduce the production of these hazardous organic compounds rather than pre-chlorination.

Background and purpose: Hypoxia occurs in ischemia and heart attack, and leads to death. It involves production of reactive oxygen species. Antioxidants exhibit antihypoxic properties. Ferula persica has distinctive antioxidant activities. Nothing is known about the protective effect of this plant against hypoxia-induced lethality in mice. Materials and methods: Protective effects of methanolic extract of F. persica aerial parts and roots against hypoxia-induced lethality in mice were evaluated by experimental models of hypoxia, asphyctic, haemic, and circulatory. Results: Aerial parts showed a very good activity in asphyctic model and at 62. 5 mg/kg the extract prolonged survival time (P< 0. 05). At 250 mg/kg it showed the same activity as phenytoin. Root extract at 125 mg/kg prolonged survival time (P<0. 001). Significant differences were seen between the effects of two extracts in all tested doses, but aerial parts were found to be stronger than root extract. In haemic model, aerial parts and roots showed similar activity in same doses (P>0. 05). They showed the same activity as propranolol (P>0. 05). Both extracts showed high activity in circulatory model and at 62. 5 mg/kg they prolonged survival time (P<0. 001). Conclusion: The extracts showed protective effects against hypoxia in all tested models. Presence of polyphenols in this plant may be a proposal mechanism for its antihypoxic activities.

Background and purpose: Colorectal cancer (CRC) is highly prevalent and conventional therapies are associated with side effects, therefore, application of novel complementary treatment such as probiotics (especially Saccharomyces cerevisiae) is necessary. The aim of this study was to investigate the effect of heat-killed form of S. cerevisiae on growing rate and apoptosis (expression levels of PTEN and RelA) in colon cancer cell line HT29. Materials and methods: In this experimental study, the cytotoxic effects of heat-killed form of S. cerevisiae and Fluorouracil (5-FU), as positive control, were tested by MTT assay. Apoptosis induction was investigated by determining the PTEN and RelA expression levels using qRT-PCR. Data were analyzed in GraphPad Prism Software. Results: Heat killed form of S. cerevisiae showed anti-proliferative and apoptotic effect by decreasing the expression levels of RelA and increasing PTEN expression levels in HT-29 cells. The expression levels were found to be significantly different between the intervention groups and controls. Conclusion: The yeast probiotics could decrease the growth rate of colorectal cancer cells and play key role in induction of apoptosis via regulation of RelA and PTEN.

Background and purpose: Pulmonary problem is one of the non-cardiac causes of exertional chest pain in children. The aim of this study was to evaluate and compare pulmonary function in children with exertional chest pain during rest. Materials and methods: This descriptive analytical cross sectional study was conducted in 200 children aged 10-15 years old in Arak, Iran 2018. The case group (n=100) included children with exertional chest pain and control group (n=100) were healthy children (without exertional chest pain). Respiratory function was assessed using spirometry after complete training and one test session. Data analysis was done in Stata 11. Results: The mean values for forced expiratory volume in the first second (FEV1), the forced vital capacity (FVC), FEV1/FVC, and peak expiratory flow (PEF) were 3. 98± 1. 56 and 4. 31± 2. 1 L/s, 4. 81± 2. 16 and 5. 2± 2. 8 L, 0. 73± 0. 13 and 0. 75± 0. 11, and 6. 89± 1. 65 and 7. 24± 1. 59 L/m in case group and healthy group, respectively. The values did not show significant differences between the two groups (P=0. 209, P=0. 272, P=0. 242, and P=0. 128, respectively). Conclusion: According to current study, spirometry evaluation in children with exertional chest pain during rest does not seem to be helpful for diagnosis of exercise-induced bronchospasm.

Background and purpose: Multiple sclerosis (MS) is the most prevalent neurological disability in young adults. This study aimed at reporting MS registry in Kermanshah province, Iran 2018. Materials and methods: In this cross-sectional study, demographic and clinical characteristics of 353 patients were recorded in MS registry. Data analysis was done in SPSS V25. Results: Patients aged 18-62 years, including 80% females (mean age: 36. 1 years) and 20% males (mean age: 37. 9 years). Almost 45% were born between 1981 and 1991. Relapsing-remitting MS (RRMS) was seen in 72%. Visual symptoms were initial signs of the disease in 37% of the patients. The mean age of onset of the disease was found to be high in patients with primary progressive MS (PPMS) and low in those with progressive-relapsing MS (PRMS). Among the patients, 87% were able to walk at least 100 meters. Conclusion: The epidemiological situation of MS in Kermanshah province is similar to other parts of Iran. Planning according to national programs are suggested for the management and control of this disease in Kermanshah province.

Background and purpose: In recent years, Health System Reform Plan has been implemented in Iran to improve health care system. Medication costs, including medical prescriptions are major parts of the budget in this project. In the meantime, health insurance plays a significant role in providing these costs. This study aimed at evaluating the effect of Health System Reform Plan on the cost of medical prescriptions of patients with Health Insurance in selected public hospitals in Sari, Iran. Materials and methods: In this analytical study, inpatient prescriptions in two periods (2011-2013 and 2014-2015) were obtained from the health insurance organization. Data analysis was done in SPSS software. Results: The trend of cost changes was not significantly different in years before implementation of the Health System Reform Plan (2011-2013) and subsequent years. But, significant cost changes were seen in 2013-2016 (P= 0. 311) and 2013-2014 (P=0. 0204). Conclusion: Implementation of the Health System Reform Plan in 2014 increased the cost of medication prescriptions for health insurance, which continued in 2015, but in most hospitals the trend declined in 2016.

Background and purpose: The risks of exposure to digital media in children are increasing in Iran and worldwide. This study aimed at evaluating the screen time of digital media and its association with behavioral problems in preschoolers. Materials and methods: A cross-sectional correlational study was performed in 274 preschoolers selected via randomized cluster sampling in two centers covered by the Ministry of Education and two centers supervised by Welfare Directorate in Kerman, Iran during the academic year 2018-2019. Demographic information was obtained and Rutter Children's Behavior Questionnaire-Parent version was administered. Results: In this study, 76. 4% of the children used digital media more than two hours per day and the usage rate of the 23. 6% was less than two hours per day. Child's gender and mother's employment and educational level were significantly associated with children screen time (P<0. 05). Total score for behavioral disorders and the aggression dimension were clearly associated with time spent viewing television (P<0. 05). Playing with a tablet device more two hours per day was significantly related to antisocial behaviors (P<0. 05). Moreover, playing with a smartphone for over two hours per day was significantly related to anxiety, anti-social behaviors, and total score for behavioral problems (P<0. 05). No significant difference was found between the mean scores of the Rutter scale and screen time (P>0. 05). Conclusion: According to this study, restricting the time spent on any form of digital media can be effective in reduction of behavioral disorders in children.

Background and purpose: Emotional distress highly affects people. Self-efficacy in emotional regulation and cognitive flexibility are among the factors that could affect the level of emotional distress. The aim of this study was to investigate the predictive role of self-efficacy in emotional regulation and cognitive flexibility on reducing emotional distress in university students. Materials and methods: A descriptive correlational study was conducted in 200 students in Iran University of Medical Sciences, 2019, selected via convenience sampling. The participants completed Regulatory Emotional Self-Efficacy (RESE) scale, the cognitive flexibility inventory (CFI), and Depression Anxiety Stress Scale-21 (DASS-21). Data analysis was done in SPSS V23 applying Pearson correlation and Hierarchical regression. Results: Findings showed a significant relationship between self-efficacy in emotional regulation and emotional distress and its components (depression, anxiety, and stress) (r=0. 53, P< 0. 01). Selfefficacy in emotional regulation was found to be a good predictor of reducing emotional distress. We observed no significant relationship between cognitive flexibility and emotional distress and its components (r=0. 01, P≥ 0. 05). But, a significant relationship was detected between self-efficacy in emotional regulation and cognitive flexibility (r=-0. 53, P< 0. 01). Conclusion: Current study proved that there is a relationship between self-efficacy in emotional regulation and emotional distress, therefore, care neededs to be taken to improve, maintain, and promote mental health in students.

Germ cell tumors account for 2 to 3% of all cancers in children. These tumors appear in the testicles as painless masses. The primary treatment of these tumors is the removal of testicles and chemotherapy. Giant cell tumor of the tendon sheath (GCTTS) is slow-growing tumor and the primary treatment of this tumor is surgery and both surgery and radiotherapy in invasive type. This report presents the case of a 7-year-old boy who was diagnosed with germ cell tumor at the age of 8 months. He had undergone surgery and chemotherapy and had recovered. At the age of 7, the patient referred with a mass in right heel and after evaluation and surgery, he was diagnosed with Giant cell tumor of the tendon sheath. Surgery was performed and no evidence of recurrence was observed in follow-up evaluation. To the best of our knowledge, this report is the first case of a giant cell tumor of the tendon sheath following the treatment of testicular germ cell tumor.

Background and purpose: In the last months of 2019, the new coronavirus infection (COVID-19) spread worldwide. This study investigated the need for mechanical ventilation in children who were admitted for COVID-19. Materials and methods: This article provides a systematic review of studies about children with COVID-19 requiring invasive or non-invasive mechanical ventilation. Electronic databases including SID, Iran Medex, Magiran, PubMed, and Google Scholar were searched using related keywords in Persian and English until July 20, 2020. Also, references in the selected articles were screened. Results: Twenty studies were selected in which 1709 hospitalized children were included. Mechanical ventilation methods were used in 15% of the patients, while in 260 non-invasive ventilation (n=130, 7. 6%) and invasive ventilation (n=130, 7. 6%) were used. In critically ill children or those who needed intensive care (n=302), non-invasive ventilation and invasive mechanical ventilation were performed in 72 (23. 8%) and 71 (23. 5%), respectively. Mortality occurred in 1. 3% of all admitted patients and 4% of critically ill children. Conclusion: According to this review, 15% of hospitalized children with COVID-19 needed a form of mechanical ventilation.