JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2021 | Volume:31 | Issue:195|Papers Count:15

Background and purpose: Understanding of the risk factors for cardiovascular artery disease, which is the leading cause of death worldwide, can lead to essential changes in its etiology, prevalence, and treatment. The aim of this study was to compare the results of logistic regression model and Classification and Regression Tree Analysis (CART) in determining the prognostic factors for coronary artery disease in people living in Mashhad, Iran. Materials and methods: The present case-control study used the cohort data of Mashhad stroke and heart atherosclerotic disorder (MASHAD STUDY), 2009. The prognostic factors for coronary artery disease were determined by CART and Logistic regression models using R and Stata 14. Then, the efficiency of the models was compared by computing the area under the performance characteristic curve (AUC). All patients with coronary artery disease were considered as the case and for each case, three controls were selected. Results: According to Logistic model, prognostic factors for coronary artery disease included age, history of myocardial infarction, diabetes, history of hyperlipidemia, and family history of heart disease (father and brother). The CART algorithm showed age, history of myocardial infarction, history of hypertension, depression, physical activity level, and body mass index as prognostic factors for coronary artery disease in people in Mashhad. Conclusion: Myocardial infarction and age were common prognostic factors for coronary artery disease according to the models applied. According to the efficiency of logistics model, binary multiple logistic regression model is suggested to be used in identifying the factors affecting coronary artery disease, if there is no interaction between the predictors.

Background and purpose: Cardiac magnetic resonance imaging (MRI) is a costly method to assess cardiac iron overload. The presence of fragmented QRS (fQRS) indicates changes due to iron overload in cardiac tissue. The aim of this study was to evaluate the correlation between fQRS and cardiac iron overload using cardiac MRI in patients with β-thalassemia major (β-TM). Materials and methods: This analytical cross-sectional study was conducted in 40 β-TM patients admitted to Arak Amir-Kabir Hospital, Iran 2018-2019. Cardiac T2* MRI was performed and values of less than 20 ms were considered as cardiac iron overload. The patients were divided into two groups (<20 and >20 ms). The presence of fQRS was assessed on 12-lead surface electrocardiogram (ECG) and compared between two groups. Results: There was a positive correlation between T2*MRI and serum ferritin (r= 0. 041, P=0. 657) and hemoglobin levels (r=0. 057, P=0. 540). The mean T2*MRI in patients with fQRS (18. 43± 7. 24) was significantly lower than patients without fQRS (26. 47± 6. 15) (P=0. 001). We found a negative correlation between T2*MRI and fQRS (r=-0. 048, P=0. 001). Conclusion: The presence of fQRS on ECGs could be a good predictor of cardiac iron overload in β-TM patients. It is believed that fQRS can indicate this change in electrocardiography and shows the need for more accurate monitoring for cardiac overload and aggressive chelation therapy.

Background and purpose: The global prevalence and morbidity of Coronavirus disease 2019 (COVID-19) are high. Preventive behaviors are proven to reduce the damage caused by the disease. There is a paucity of information on determinants of preventive behaviors in response to COVID-19 in Mazandaran province, north of Iran. So, we aimed to evaluate protection motivation theory (PMT) in promoting preventive behaviors of COVID-19 in Mazandaran province. Materials and methods: In this descriptive cross-sectional study, 1220 individuals participated. They were selected via social networks using convenience sampling in 2020. Data were collected online using a demographic questionnaire and a valid and reliable scale based on PMT. Data analysis was done using Pearson correlation coefficient and linear regression in SPSS V24. Results: Mean age of the participations was 39. 34± 8. 74 years. Regression model showed perceived threat (ß =0. 033, P =0. 007), perceived costs (ß =0. 039, P=0. 045), perceived self-efficacy (ß =0. 116, P>0. 001), and perceived fear (ß =0. 131, P>0. 001) as the significant predictors of COVID-19 preventive behaviors. This model accounted for 78% of the variance in these behaviors. Conclusion: According to constructs of the PMT associated with protection against COVID-19, educational programs and health promotion based on the theory and benefiting from social networks could be helpful in increasing the motivation of people towards protective behaviors of COVID-19.

Background and purpose: Vitamin D deficiency is highly prevalent in Iran. Death toll due to the Coronavirus Disease 2019 (COVID-19) is high in this country. The purpose of the present investigation was to provide more information on the relationship between serum levels of vitamin D in confirmed cases of COVID-19 in north of Iran. Materials and methods: This cross-sectional descriptive study was performed in COVID-19 patients (n=80) attending Sari Imam Khomeini Hospital, Iran 2020, who were confirmed for COVID-19 infection with CT-Scan or RT-PCR. Seventy healthy individuals were also examined as the control group. SPSS V19 was applied for data analysis. Results: In this study, 80 patients with COVID-19 (mean age: 57. 22 ± 17. 44 years old) and 70 healthy individuals (mean age: 48. 69 ± 12. 99 years) were studied. There were 38 and 35 males in these two groups, respectively. Serum Vitamin D levels were significantly lower in patients with COVID-19 than those in the control group (18. 72 ± 12. 53 vs. 30. 86 ± 15. 19 ng/ml, P< 0. 001). Conclusion: This study showed that serum levels of Vitamin D were lower in patients with COVID-19 than healthy individuals and frequency of Vitamin D deficiency was higher in these patients. Hence, further studies are needed to clarify the role of serum Vitamin D concentrations in patients with COVID-19 infection.

Background and purpose: Theory of Mind (TOM) is a cognitive ability to understand the beliefs, emotions, and desires of oneself and others, and its development is associated with proper development of other cognitive skills, including language. This study aimed at investigating the relationship between language and TOM and comparing the grammatical and lexical performances and TOM skills between children with high-functioning autism (HFA) and developmental language disorder (DLD) and typically developing (TD) children. Materials and methods: A cross-sectional study was carried out in 50 children aged 6-11 years old, native speakers of Persian language, with DLD (n= 14) and HFA (n= 11), and in TD (n= 25) children. Assessment of language skills was done by lexical and syntactic indicators obtained from the analysis of narrative speech sample and Persian grammar expression test (PEGT) and TOM skills using Persian mind theory test. Data were analyzed in SPSS V22 using ANOVA, Pearson Correlation, Kruskal-Wallis test, and Spearman correlation. Results: There were no significant differences in most grammatical, lexical, and TOM scores between children with DLD and HFA (P<0. 05), but the performances of both groups were found to be significantly lower than TD children (P>0. 05). Significant correlation was observed between overall scores and TOM and PEGT scores in all three groups (P<. 05). Conclusion: The current study revealed that children with HFA and DLD have weaker TOM skills than TD children which could be due to their language deficits.

Background and purpose: Ticks, as ectoparasites, biological vectors and reservoirs of various diseases, are involved in transmission of pathogens to humans and animals. This research aimed at modeling the probability of tick vectors presence in Ahvaz, Hamidiyeh, Bavy, and Karoon in southwest of Iran. Materials and methods: To perform the modeling, eight criteria (slope, elevation, soil texture, land use, land cover, temperature, humidity, and rainfall) that strongly affect the distribution of ticks were selected. After pairwise comparisons, Super Decision Software was used to determine the significance of each criteria and the weight of sub-criteria was calculated using Expert Choice11. Weighted maps were obtained based on the effect of sub-criteria weights on maps. The final map of the probability of tick vectors presence was prepared based on the weight effect of each criteria in the weighted maps. Results: Average relative humidity (0. 252), average rainfall (0. 179), and land cover (0. 151) were found to have the greatest effect on the probability of tick presence. Also, the highest probability of tick presence was seen in following cities and rural districts: Ahvaz, Hamidiyeh, Karoon, Bavy, Meshrahat, Karkheh, Qaleh Chenan, and Anafcheh. Conclusion: In current modelling, considering ecological, topographic, and climatic factors, the probability of the presence of vectors of Crimean-Congo haemorrhagic fever (CCHF) virus was seen to be very high in two rural districts, including Mashrahat (Ahvaz) and Karkheh (Hamidiyeh).

Background and purpose: Flies have a high diversity and are able to transmit many pathogens due to their adaptation and close relationship with humans. Therefore, this study was performed to identify the fauna of medically important flies in the city of Joybar in northern Iran. Materials and methods: This descriptive-analytical study was conducted twice a month in Juybar at selected sites, including hospital landfills, coastal waste, rural waste, municipal waste, and around a slaughterhouse in 2017. The flies were identified using valid identification keys and the species diversity parameters were evaluated based on Shannon index, Margalef index, and Evenness index. Results: In this study, seven species of medically important flies, including Muscina stabulans, Musca domestica, Lucilia caesar, Lucilia sericata, Calliphora vicina, Sarcophaga argyrostoma and Sarcophaga africa were caught from Muscidae, Calliphoridae, and Sarcophagidae families. According to Pearson correlation, the population of flies increases significantly (P<0. 005) with increasing temperature and decreasing humidity. Shannon index showed the highest and lowest diversity values in coastal waste (H´ =1. 005) and urban waste (H´ =0. 27), respectively. Conclusion: Mosca domestica, as the most common and abundant species could considerably affect the health of the region and cause changes in the species diversity of flies. The difference in diversity of flies in different areas is mainly due to changes in the species evenness in these areas. Also, the diversity of flies in the region can be a warning sign for the spread of diseases. Control measures such as appropriate waste management are necessary to prevent epidemic outbreaks transmitted by flies.

Background and purpose: Acquisition of basic skills and professionalism in medicine depends on the quality and quantity of education in clinical settings. This study aimed at assessing the quality of clinical education in different departments of Mazandaran University of Medical Sciences. Materials and methods: This descriptive study was conducted in medical clerkships and interns (n=175). The participants were selected via census sampling in 2019. Data were collected using a checklist based on clinical education standards of Iran Ministry of Health and Medical Education. Written comments from clerkships and interns on the compliance of morning report training programs, clinical trainings, clinical rounds, grand rounds, journal club, and clinical skills center with clinical training standards were received. Data analysis was performed in SPSS V16. Results: The morning report program and clinical skills center program had the highest (85. 1%) and lowest (72. 2%) scores in clinical education. We observed significant differences between these scores and the scores for other clinical programs (P>0. 05). The quality of all clinical education programs was similar according to men and women. The clerkship and interns had different ideas about the status of all clinical education programs except in the morning report program and the clerkship were more satisfied with clinical education programs. Conclusion: From the students' point of view, the morning report program was of acceptable quality, but the clinical training programs, club journal, grand rounds, and clinical skills center had some drawbacks. Training workshops for clinical professors is recommended to enhance the standards of clinical training programs.

Background and purpose: Highly Pathogenic Influenza A(H5N1) viruses cause vast economic losses throughout the world. They may circulate in animals and be able to spread from human to human. Therefore, launching diagnostic tests are highly essential to control the influenza infection. Studies on the amino acid sequence of the neuraminidase (NA) protein of influenza viruses revealed that NA is the most immunogenic protein in naï ve animals which can simply stimulate the humoral immune system well. Materials and methods: Influenza virus NA gene (A/Indonesia/5/2005(H5N1) was cloned into pET21a and expressed in host E. coli (BL21) strains. Then, the expression level of NA protein was optimized for different IPTG inductor concentrations and times. Results: Findings showed the integrity of pET21a-NA construct. Emerging bands with the expected molecular weight (38KDal) on SDS-PAGE and WB analysis confirmed the successful expression of target protein in E. coli BL21 strain. In silico analysis showed integrity of major epitopes in the structure of fused version of NA produced in this work. Conclusion: The new recombinant NA has the potential to be used directly in serological tests. It could be also used in polyclonal antibody preparation which is employed as an essential material in western blot analyses and other immunological and serological studies, such as ELISA, immunocytochemistry, and immunohistochemistry.

Background and purpose: Glycopeptide resistance genes can be transmitted to clinical strains from gram-positive environmental bacteria and the normal flora. The aim of this study was to evaluate the prevalence of vancomycin and teicoplanin-resistant Enterococcus faecalis and Enterococcus faecium isolates in hospital environment and fecal samples of healthy individuals. Materials and methods: Human stool and hospital environment samples were collected and inoculated on selective M-enterococcus agar medium. Then, E. faecalis and E. faecium were identified using phenotypic and molecular methods. Antibiotic susceptibility pattern of the isolates against teicoplanin and vancomycin was determined by micro-broth dilution method. Data were analyzed in SPSS applying Chi-square test. Results: From 145 isolates, E. faecalis and E. faecium were detected in 84 (54. 93%) and 61 (42. 07%) isolates, respectively. One (1. 19%) E. faecalis isolate and 4 (6. 56%) E. faecium isolates were resistant to vancomycin, while 4 (6. 56%) E. faecium isolates were found to be resistant to teicoplanin. The minimum inhibitory concentrations of 50 (MIC50) and 90 (MIC90) for vancomycin and teicoplanin in E. faecalis and E. faecium were 4 and 16 μ g/ml, respectively. Conclusion: The MIC results of vancomycin and teicoplanin showed that most of enterococci isolates studied were sensitive to these two antibiotics. Therefore, their use should be closely monitored to prevent resistance.

Identifying and determining the origin of the first human case of COVID-19, which has caused pandemic will be of great benefit in preventing and controlling next epidemics and pandemics. The first confirmed case of COVID-19 was reported in December 2019 in China. This article reports three cases of pneumonia compliant with COVID-19 admitted to Qaemshahr Razi Hospital in Mazandaran province, Iran before the first official report of confirmed case of the disease (November-December 2019). The pattern of radiological involvement was completely consistent with COVID-19 in all three patients. Two patients died of acute progressive respiratory failure despite supportive respiratory therapy and systemic corticosteroids, and the other patient recovered. Study of these cases highlights the fact that emerging and re-emerging diseases should be considered in management of patients with infection and unusual symptoms.

Background and purpose: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the major hospital and non-hospital pathogens in children. This meta-analysis and systematic review aimed at exploring the data on prevalence of MRSA in Iranian children. Materials and methods: Primary articles in English and Persian were searched using the following keywords: prevalence, children, methicillin-resistant staphylococcus aureus (MRSA), and Iran. Electronic databases, including Pubmed, Web of Science, Google Scholar and Iranian databases such as Magiran and SID were searched for articles published in 2007-2019. Qualitative assessment of studies was done using STROBE checklist and data analysis was done in STSTA V11. Results: A total of 55 articles were identified and 23 met the study inclusion criteria. The prevalence of MRSA in children with S. aureus infection was 22%. The prevalence of community acquired and nosocomial MRSA was 17% and 38%, respectively. Conclusion: The current meta-analysis showed considerable rates of nosocomial and community acquired MRSA infections among children in Iran. So, pediatricians should consider this issue in empirical treatment.

Background and purpose: In the time of emerging infectious diseases, quarantine is one of the necessary preventive measures to maintain public health. This study aimed at reviewing the determinants of quarantine compliance in epidemics in synchrony with the coronavirus disease 2019 (COVID-19). Materials and methods: A systematic scoping review of studies (2000-2020) on quarantine determinants was done in both Persian and English. PubMed, Embase ProQuest, Science Direct, Google Scholar, MagIran, SID, Iran Doc, and Element were searched using the following keywords: quarantine, social distancing, home quarantine, infectious epidemic, compliance, acceptance, adherence, and noncompliance in both Persian and English. Results: A total of 13, 755 articles were found of which 10 eligible studies were included in this review. The main factors inhibiting adherence to the COVID-19 quarantine were financial problems following job loss, lack of adequate education and awareness, low levels of education, psychological pressures, difficulty of the quarantine period, lack of trust, and low supervision. Factors influencing adherence to quarantine included awareness, creating voluntary conditions, clear communication, offering assurance about jobs, moral commitments, high levels of education, and living in urban areas. Economic incentives and effective informative and training campaigns could increase public compliance with quarantine. Conclusion: There is paucity of information about compliance with quarantine during COVID-19 pandemic, therefore, further studies on this issue are needed in Iran and other countries.

Background and purpose: The world has made unprecedented efforts to control the Coronavirus disease 2019 (COVID-19), however, the number of positive cases are increasingly being seen every day. Therefore, there is an urgent need for more effective preventive measures to limit the spread of the infection which require more precise understanding of the routes of transmission and its stability in different environments. Materials and methods: In this review, all articles published up to September, 2020 on the stability of coronaviruses, including SARS􀀀 CoV􀀀 2 were studied. PubMed, Scopus, Web of Science, Sciencedirect and Google Scholar were thoroughly searched. Keywords used in the search were Coronavirus, SARS-CoV-2, COVID-19, and Stability. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) updates were also used for the latest information on the disease. Results: Transmission of SARS􀀀 CoV􀀀 2 was observed to be through aerosols. SARS-CoV-2 and other human and animal coronaviruses have very low stability on low porosity surfaces. The stability of SARS-CoV-2 on surfaces in vitro was similar to that of SARS-CoV-1. Some coronaviruses can survive for many hours to days in fecal, water, and wastewater samples. Findings showed the risk of transmission of SARS􀀀 CoV􀀀 2 through fecal-oral route and water contaminated by wastewater. Coronaviruses survive at lower temperatures and lower relative humidity. Conclusion: There are still many challenges to the survival of coronaviruses and very little data is currently available. Lack of effective treatment and vaccines call for more protective measures and good personal hygiene to avoid infection and preventing its spread.

Global prevalence of neurological disorders such as Parkinson's disease, Alzheimer's disease, epilepsy, and multiple sclerosis is steadily increasing, but, there is still no effective delivery system to deliver therapeutic amounts of drug into the central nervous system (CNS). The blood-brain barrier is the major component to control the entrance of drugs into the brain. Recent studies introduced intranasal drug delivery as a suitable method of drug delivery for bypassing blood-brain barrier and treatment of neurological diseases. The nasal route has been repeatedly examined in several preclinical models to investigate the delivery of drug to the brain via nanoparticles. Among various carriers utilized for drug delivery via nasal route, chitosan is widely used due to being effective in modulating drug charge. Key features of drug delivery systems through nasal route include easy drug delivery, higher stability in nasal cavity, increased penetration ability of drugs through nasal epithelium, and decreased drug metabolism. The present review investigated novel nano-formulations for drug delivery via nose to brain in treatment of major neurological disorders. In preclinical studies, intransaal nanoparticle-based drug delivery systems are found to be more promising, effective, and targeted. However, more preclinical studies are needed to confirm their non-toxicity and beneficial effects.