Journal of Mazandaran University of Medical Sciences
Year:2021 | Volume:31 | Issue:197|Papers Count:20

Background and purpose: There is little evidence about the effect of exercise trainings with different intensities and resveratrol on Nonalcoholic Fatty Liver Disease (NAFLD) indexes. This investigation aimed at studying the effect of 8 weeks of high and moderate intensity exercise training and resveratrol supplementation on alterations of FGF-21 and Cytokeratin-18 levels in NAFLD rats. Materials and methods: In this experimental study, 48 adult male rats (210± 10 gr) were randomly divided into six groups, including a healthy control group, a patient group, rats that received saline, some to do high and moderate intensity exercise trainings, and animals that received resveratrol (10 mg/kg/day). High fat emulsion was used to induce NAFLD. Exercise trainings were performed at 8 weeks, five times a week for 45 minutes. We measured serum levels of FGF-21 and Cytokeratin-18 by ELIZA and FGF21 mRNA by PCR real time method. Data were analyzed by one-way analysis of variance and Tukey’ s post-hoc test. Results: The serum levels of FGF21 mRNA, FGF-21, and Cytokeratin-18 showed significant decrease in resveratrol group, and high and moderate intensity exercise groups compared to the patient group (P≤ 0. 001), but were not significantly different among these three groups (P≤ 0. 001). Conclusion: The resveratrol supplementation, and high and moderate intensity exercise trainings could decrease FGF-21 and Cytokeratin-18serum levels in NAFALD rats.

Background and purpose: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disorder in the world. Genetic factors are believed to be associated with development of NAFLD. This research aimed at studying the effect of eight weeks of compound exercises (aerobic and resistance) on human body with three genotypes (TT, CT, CC) of C677T polymorphism of methylenetetrahydrofolate reductase gene. Materials and methods: In this semi-experimental study, human body of grade 1 NAFLD subjects (N=60) were studied in six groups (3 control groups and 3 experimental groups) with three genotypes (TT, CT, CC) for eight weeks. The participants were obese males aged 30-40 years old (BMI= 30-35 kg/m2). Data analysis was carried out in SPSS V19 applying repeated measures analysis of variance. Results: The study showed significant decrease in BMI at the end of 8 weeks of training protocol in TT genotype group compared to those with CT (P= 0. 031) and CC (P= 0. 023) genotypes. Also, visceral fat showed significant decrease in group with TT genotype compared to the groups with CT genotype (P= 0. 039) and CC genotype (P= 0. 034) and in CT genotype group compared to CC genotype group (P= 0. 046). A decreasing trend was observed in all groups in waist to hip ratio, although the decrease was not significant among the genotypic groups. Conclusion: Training protocol resulted in BMI reduction which was found to be higher in TT genotype compared to CT and CC genotypes. Reduced visceral fat after these exercises along with lower BMI could cause improvements in liver function in patients with NAFLD.

Background and purpose: Statins are among the most widely used drugs in treatment of cardiovascular diseases. Reducing the side effects of these drugs is of great importance in preventing treatment failure. The aim of this study was to investigate the role of rs4149056 polymorphism in statin-induced myopathy in patients with cardiovascular diseases in West of Mazandaran province, Iran. Materials and methods: A descriptive cross-sectional study was carried out in 161 patients taking atorvastatin who attended Cardiovascular Clinic in Ramsar Imam Sajjad Hospital and Tonekabon Shahid Rajaee Hospital, 2017-2018. All patients were given atorvastatin at 40 mg daily for 8 weeks and all lipid markers and CPK enzyme levels as a measure of myopathy were measured. Then, the patients received atorvastatin at 20 mg for 4 weeks and all lipid markers were measured again. PCR-ARMS method was used to determine the distribution of rs4149056 polymorphism. Results: According to findings, reducing the dose of atorvastatin caused significant differences in total cholesterol and LDL levels (P<0. 05), but the mean of these changes was not significant between different genotypes (P>0. 05). Drug dose change caused significant differences in levels of triglycerides in patients with TC genotype and HDL in patients with CC genotype (P<0. 05). Moreover, in patients with CC genotype, the percentage of those with high levels of CPK was two times higher than patients with normal CPK. Conclusion: Current study could be of help in predicting the incidence of myopathy in patients receiving statins and preventing the side effects of these drugs.

Background and purpose: The association between ABO blood types and Coronavirus disease 2019 (COVID-19) have been investigated in several studies but there are inconsistencies in results. The purpose of this study was to investigate the association between ABO blood types and COVID-19 infection based on serologic results. Materials and methods: A cross-sectional seroepidemiologic study was carried out in 1504 people living in Mazandaran province, north of Iran. Blood samples were drawn to determine blood groups. Also, IgG and IgM antibodies were measured by ELISA. Data analysis was done using Chisquare, Fisher’ s exact test, univariate and multivariate logistic regression analyses in SPSS V25. Results: The frequency of IgG positive among blood groups A, B, AB, and O was 12. 7%, 11. 8%, 9. 4%, and 9. 6%, respectively. After adjusting for suspicious confounding factors, the odds ratio of COVID-19 infection was 1. 19 (95% CI: 0. 85-1. 67) in blood group A, 1. 33 (95% CI: 0. 94-1. 87) in blood group B, 0. 82 (95% CI: 0. 44-1. 55) in blood group AB, and 0. 70 (CI 95%: 0. 50-0. 98) in blood group O based on serologic results (IgG+/IgM+). Conclusion: The odds ratio for COVID-19 was significantly lower (30%) in blood group O compared to other blood groups, so blood group O can be considered as a protective factor against COVID-19.

Background and purpose: Adenoviruses and enteroviruses as intestinal viruses are detected in wastewater. Fecal shedding of 2019 novel coronavirus (SARS-CoV-2) has been reported in some studies. Therefore, determining the presence of these viruses in wastewater is important to maintain public health and helps in predicting and preventing viral infections in a community. Materials and methods: In this analytical study, 24 raw wastewater samples were taken from two municipal wastewater treatment plants and viral nucleic acids were extracted. Finally, the presence of adenovirus was detected by real-time PCR, and SARS-CoV-2 and enterovirus were detected using RT Real-time PCR. Results: Nine (37. 5%) samples were found to be positive for SARS-CoV-2. Also, 19 (79%) and 6 (6%) samples showed the presence of adenovirus and enterovirus, respectively. Conclusion: Detection of SARS-CoV-2, enterovirus, and adenovirus in wastewater samples indicated the prevalence of viral infections in the community served by two wastewater treatment plants studied. The presence of viruses in wastewater shows that monitoring of wastewater could be used as an important tool for the survey of viral infections in the community.

Background and purpose: Almost half of non-specific knee pain can be attributed to patellofemoral pain syndrome (PFPS). There is paucity of information about the effects of different types of combination therapies including exercise and taping and optimizing training variables. The aim of this study was to evaluate the effectiveness of combination of taping and quadriceps strengthening and hamstring stretching exercises on PFPS. Materials and methods: In a randomized clinical trial, 60 male patients (20-50 years old) with PFPS were randomly divided into four groups: 1) Quadriceps strengthening exercise and taping, 2) Hamstring stretching exercise and taping, 3) Quadriceps strengthening and hamstring stretching exercise, and 4) Quadriceps strengthening, hamstring stretching exercise, and taping. Pain and functional outcomes were assessed before and immediately after treatment using VAS scale, KOOS scale, and 6 MWT test. Data were analyzed in SPSS V20. Results: Compared to beginning of the study, significant decrease in mean VAS scores (P<0. 001) and significant increase in mean KOOS scores and 6 MWT test were found in all groups after treatment (P<0. 001). However, the increase in 6MWT test score was not significant in group 4. Conclusion: Combination of quadriceps strength training and hamstring stretching improved PFPS in all four groups. Lack of significant differences between the groups studied suggests that combination of two treatments has a similar effect to the combination of three treatments.

Background and purpose: Adolescence is an important and vital stage of life that is associated with physical, emotional, and evolutionary changes. The purpose of this study was to investigate the effectiveness of mindfulness-based counseling approach on health promoting behaviors in adolescents with premenstrual syndrome (PMS). Materials and methods: A quasi-experimental study was conducted in 86 students with PMS selected from high schools in Meybod, Iran 2019. They were randomly divided into intervention group (n= 43) and control group (n= 43). The intervention group attended counseling sessions based on mindfulness approach for 8 sessions/2 hours/ a week. Demographic characteristics were recorded and Health-Promoting Lifestyle Profile II (HPLP-II) and premenstrual symptoms screening tool (PSST) were administered. The scales were completed in both groups at beginning of the study, and at weeks eight and 12 after the intervention. Data analysis was performed in SPSS V19 applying independent t-test, repeated measures test, and LSD test. Results: There was no significant difference between the two groups in demographic variables (P>0. 05). Before the intervention, there was no difference between the two groups in mean scores for health-promoting behaviors (P= 0. 161), but, compared to the control group, the mean scores for healthpromoting behaviors in intervention group showed significant increase immediately and one month after the intervention (P<0. 001). Conclusion: Mindfulness-based cognitive therapy was found to be effective in improving health promoting behaviors in students with PMS which could create effective and fundamental changes in adolescents’ behaviors towards achieving a healthy society.

Background and purpose: Improving quality of life is one of the goals of care that helps in preventing chronic conditions such as metabolic syndrome. The aim of this study was to determine the effect of self-management training based on group cognitive-behavioral therapy on quality of life in adults with metabolic syndrome. Materials and methods: This randomized clinical was carried out in 80 adults with metabolic syndrome in 2019. They were divided into intervention group and control group (n=40 per group) using permutation block method. The WHOQOL-BREF was administered before and three months after the intervention. Self-management trainings based on cognitive-behavioral therapy were performed twice a week in intervention group during 8 sessions of 90 minutes, while the control group received only routine care. Data were analyzed using Chi-square, independent t-test, paired t-test, and analysis of covariance. Results: The mean scores for quality of life and also dimensions of physical health, mental health, and social relations in intervention group were 42. 14± 5. 18, 45. 53± 9. 32, 40. 38± 7. 44 and 43. 32± 6. 43, respectively before the intervention that increased significantly to 56. 38± 7. 23, 71. 22± 13. 35, 65. 29± 8. 56 and 48. 76± 6. 95 after the intervention (P<0. 001). But, no significant difference was observed in environmental health dimension before and after the intervention (P= 0. 345). Findings showed no significant differences in pretest and posttest scores for quality of life and its dimensions in the control group (P> 0. 05). Conclusion: Self-management training based on cognitive-behavioral therapy can improve the quality of life in adults with metabolic syndrome.

Background and purpose: Given the role of cancer stem cells in cancer, the aim of this study was to determine the expression of LGR5 marker in gastric cancer and its association with cagA genotype of Helicobacter pylori infection. Materials and methods: A case-control study was performed in gastric biopsy specimens from antrum and body during endoscopic examination of patients attending Sari Touba Clinic, 2017-2018. After reviewing the patient records, the samples from those aged 50 and higher were studied. Case group included gastric cancer specimens with H. pylori infection (n=30) and control group included noncancerous samples with H. pylori infection (n=30). LGR5 expression and presence of cagA were evaluated by IHC and PCR methods, respectively. Results: The mean ages of gastric cancer and control group were 69. 5± 10. 1 and 62. 3± 7. 8, respectively (P= 0. 003). Twenty three patients (76. 7%) in cancer group and 24 patients (80%) in control group were positive for cagA genotype. Overexpression of LGR5 was observed in 15 patients (51. 7%) with gastric cancer and 11 patients (39. 3%) in control group (P= 0. 429). LGR5 was also overexpressed in 18 cases (40. 9%) with cagA positive genotype and 8 cases (61. 5%) with negative cagA genotype (P=0. 22). Conclusion: High expression of LGR5 was observed in half of patients with gastric cancer but it was not significantly associated with cagA H. pylori genotype.

Background and purpose: Conventionally, rotary devices were used for bone surgery. Recently, new techniques have been proposed such as piezosurgery. The prevalence of impacted teeth which should be removed is high. There are different techniques for bone removal that are associated with specific complications. This study compared the postoperative complications of impacted third molar extraction between piezoelectric method and conventional surgical handpieces. Materials and methods: A cohort study was done in 40 patients (mean age: 22. 05± 4. 13 years) including 20 men and 20 women. They were randomly assigned into two groups to receive either piezosurgery (group A) or conventional handpiece (group B). The participants were recalled after three days and pain and mouth opening were compared with those of baseline scores as well as dry socket. SPSS v. 25 was used for data analysis. Results: The mean difference in mouth opening was significantly lower in group A than group B (P<0. 001). There were no significant differences in pain level between male and female patients and between the two groups (P>0. 05). But, patients in piezoelectric group were more satisfied with their surgery. Dry socket was observed only in two cases of group B. Conclusion: The benefits of handpiece method is high speed in operation and lower costs. However, the piezoelectric method is newer, more convenient, and has less trismus than the handpiece method.

Background and purpose: Hospital infections are one of the major challenges that health systems are faced with, leading to economic, social, and psychological damages. Clinical staff play an important role in controlling nosocomial infections, so, this study was conducted to design a standard questionnaire to assess the knowledge, attitude, and practice of clinical staff about nosocomial infections. Materials and methods: A mixed method confirmatory study was performed to develop an instrument in Tehran, Iran 2019. The items of the questionnaire were extracted for clinical staff by searching electronic databases, including SID, Magiran, PubMed, Scopus, Science Direct, and Google Scholar. The initial questionnaire was designed and its validity was assessed by 10 experts in hospital infection control. To assess construct validity, the questionnaire was completed by 180 clinical staff working in hospitals in Tehran. Cronbach's alpha and retest were used to assess the reliability of the scale. Results: The Content Validity Index and Content Validity Ratio for the questionnaires in three domains of awareness, attitude, and performance ranged 0. 8-1. The face validity of the questions ranged 2. 1-4. 5. In Knowledge about nosocomial infection, Richardson's coefficient was 0. 75 and Cronbach's alpha of attitude and practice were 0. 71 and 0. 82, respectively. Pearson correlation coefficient obtained in retest for knowledge, attitude, and performance were 0. 91, 0. 85, and 0. 92, respectively. Three-factor confirmatory analysis showed that the questionnaire has a good fit. Conclusion: The questionnaire designed for clinical staff has good validity and reliability which is suggested as a valid questionnaire in future researches.

Background and purpose: Radiation therapy as a part of cancer treatment is used in almost 50-60% of involved cases. In prostate cancer radiation therapy, a large volume of pelvis is irradiated, so, it is necessary to preserve sensitive organs around the treatment area, especially rectum and bladder. In this study, some dosimetric parameters such as minimum dose (Dmin), maximum dose (Dmax), mean dose (Dmean) to target (PTV) and organs at risk (OAR), Integral dose, Homogeneity Index and Conformity Index were compared between two techniques. Materials and methods: In this analytical study, computed tomography scans of 50 patients (mean age: 52 years) attending Sari Imam Khomeini Hospital were acquired and transferred to the 3D treatment planning system (TPS). For each patient, a conventional plan (Box Fields) and modified oblique four-field (MOFF) plan were prepared using TPS for 15 MV photon energy. A total dose of 7200 cGy was prescribed for each patient. Data analysis was carried out in SPSS applying paired-t-test. Results: In current study, 15-MV energies for radiation of pelvis and bladder using box radiation fields (routine plan) lead to maximum uniformity and homogeneity of dose in irradiated tumor tissue. The results also showed that 15-MV energies for radiation of pelvis and bladder and the new plan could decrease the average integrated dose in femur heads. Conclusion: We observed a significant effect of the geometrics of radiation fields on distribution of dose in tumor tissue and also the amount of dose received by organs at risk in radiotherapy of patients with prostate cancer.

Background and purpose: The population of retired teachers is increasing every year. Studies show that several factors are effective in understanding aging and feelings about that in retirees. One of these factors is spiritual health. This study aimed to determine the relationship between spiritual wellbeing and perception of aging in retired teachers. Materials and methods: This descriptive analytical study was conducted in 350 retired teachers under the auspices of Sari Retirement Association in Iran, 2019. Data were collected using the Spiritual Well Being Scale and the Aging Perceptions Questionnaire. Data analysis was carried out applying t-test, Mann Whitney test, and regression test in SPSS V16. Results: Mean age of participants was 65. 3± 4. 3 years. The results showed that 43. 1% did not actually feel old while 56. 9% of those questioned felt aged. The mean scores for perception of aging and spiritual health were 99. 3 ± 16. 9 and 94. 1 ± 17. 5, respectively. Pearson correlation coefficient showed a significant negative correlation between spiritual health and the feeling of aging (r =-0. 213, P <0. 001). Conclusion: We observed inverse relationship between spiritual health and the feeling of aging in retired teachers, so, it is necessary to develop appropriate protocols to increase spiritual health which will consequently lead to better perception of aging in older adults.

Background and purpose: Many indicators can be used in evaluating and comparing any software, but, currently there are no indicators to compare software applications that separate tumor tissue from healthy tissue in magnetic resonance imaging (MRI) of the brain. The aim of this study was to determine appropriate criteria for selecting a proper software for tumor diagnosis in brain MRI. Materials and methods: A qualitative applied research was designed and performed in 10 stages. Appropriate criteria for selecting the software were determined using Delphi technique and expert opinions (30 people). They were then weighted and prioritized. Results: In this study, a questionnaire was developed which was completed by Information Technology (IT) specialists and software engineers. We extracted 15 criteria, among which the "possibility of using the results in education" was the most agreed (93%) criterion and the "possibility of using software in medical environments" was the least agreed (47%) criterion. Also, these two criteria had the highest and lowest relative weights (0. 1443 and 0. 011, respectively). Conclusion: : According to this study, IT specialists and software engineers believe that current software applications are more suitable for education and research than diagnosis and treatment. Therefore, they will categorize software applications according to their efficiency in research and education.

Background and purpose: Some problems that people face in childhood and adolescence remain throughout their lives. One of these problems is cancer. This study examined the effectiveness of group play therapy based on choice theory on anxiety, depression, and pain symptoms in children and adolescents with cancer. Materials and methods: An experimental study with intervention and control group and pre and post-tests was performed in 30 patients with cancer in Mashhad Dr. Sheikh Hospital, 2019. Demographic form, Hospital Anxiety and Depression Scale (HADS), and the Chronic Pain Grade Questionnaire (CPGQ) were completed before and after the intervention. Participants were randomly assigned into an intervention group and a control group. The intervention group, received eight hours of group play therapy based on choice theory in eight sessions. Data analysis was done in SPSS V24 applying Mixed model ANOVA. Results: The intervention was found to have a significant effect on anxiety level and pain intensity (P <0. 05). Conclusion: According to this study, group play therapy based on choice theory could be of great help in reducing anxiety and pain intensity in children and adolescents with cancer.

Background and purpose: Endoscopic third ventriculostomy (STV) is an important technique used in treatment of various forms of adult hydrocephalus and, in many cases, is more effective than traditional shunts. This study aimed at investigating the results of ETV in patients with normal pressure hydrocephalus. Materials and methods: This cross-sectional descriptive study was performed in 20 patients with normal pressure hydrocephalus attending Sari Imam Khomeini Hospital (2018-2020) after considering the inclusion/exclusion criteria. All patients were evaluated by the grading system of the Japanese Committee for Scientific Research on Intractable Hydrocephalus (JCSRIH). Pre-ETV indicators included: age, ICP, largest diameter of the frontal horns of the lateral ventricles, maximum width of cranial cavity, and Evans Ratio. The patients were evaluated before and after ETV, and also one week, one month, and 6 months later. Ventriculoperitoneal (VP) shunting was performed after one week, if there was no improvement in clinical symptoms. Results: The participants included 65% men and 35% women (mean age: 75. 40 ± 4. 12 and ICP: 11. 35 ± 0. 87 mmgh). VP shunting was carried out in 55% of the patients due to lack of improvements in clinical conditions after a week. In 45% of patients, after one week, 2-3 degrees improvements were seen in symptoms based on the JCSRIH scale (P> 0. 05). Conclusion: ETV can be an effective treatment in patients with normal pressure hydrocephalus. Further studies are needed to clarify the pathophysiology of the disease and the dynamics of CSF.

Background and purpose: Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome (SARS-CoV-2). Rapid spread of the virus around the world shows that identification of transmission routes and preventing environmental contamination, especially in healthcare settings plays a vital role in controlling the disease. In this study, air and surface contamination with SARSCoV-2 were evaluated in different wards of Hajar Hospital in Shahrekord. Materials and methods: In current study, 13 samples of different surfaces and 15 air samples were taken using sterile swabs impregnated with VTM and standard impinger, respectively. Detection of SARS-CoV-2 was performed using RT-PCR. Results: Findings showed that 46. 15% of surface samples and 26. 66% of air samples were positive for SARS-CoV-2 RNA. These contaminations were detected only in areas which were in close contact with COVID-19 patients. Conclusion: This study confirmed the contamination of air and surface with SARS-CoV-2 in COVID-19 admitting wards. Therefore, personal precautionary measures, including frequent handwashing, timely changing of face mask, and using more protective equipment are highly recommended in healthcare settings. Moreover, cleaning and regular disinfection of surfaces and equipment and appropriate ventilation of wards are crucial for preventing the disease transmission.

Background and purpose: Inpatient costs constitute a major part of health systems expenditure. The aim of this study was to investigate the changes in the level and trends of average inpatient cost in Behshahr Imam Khomeini Hospital during implementation of the Family Physician Plan (FPP) and Health Transformation Plan (HTP). Materials and methods: In this longitudinal study based on Interrupted Time Series (ITS), the data included monthly average inpatient cost in Behshahr Imam Khomeini Hospital during seven years (2011-2018). Data analysis was conducted in segmented regression model in R 3. 6. 1. Results: The growth rate of the number of inpatient cases was negative for two consecutive years after implementation of the FPP. The highest growth rate of average inpatient cost was 83% that occurred in 2014 (the first year after implementation of HTP). The change in the level of average inpatient cost at the beginning of the HTP was significant (P<0. 001) compared to before that which increased by 3, 896, 826 Rials. Conclusion: Over the past decade, change in the average cost of hospitalization has experienced a heterogeneous trend influenced by the FPP and the HTP. Further studies are recommended to investigate the impacts of different components and packages of these reforms on health spending.

Background and purpose: Neonatal period is a very important and vulnerable period that causes physiological adaptations to the ectopic environment. Undoubtedly, the first step in reducing infant mortality is to identify associated factors. The main cause of infant mortality is preterm birth. This study aimed at investigating the prevalence and factors associated with preterm infant death. Materials and methods: In this cross-sectional study, 150 infants were classified into four groups: 24-28 weeks, 28-32 weeks, 32-34 weeks, and 34-37 weeks. Infant mortality rate and related factors were compared between the groups. Data analysis was performed in SPSS V20. Results: Findings showed a significant relationship between infant mortality and gestational age (P<00. 01). There were no significant relationships between infant mortality and neonatal gender (P= 0. 264), type of pregnancy (P= 0. 548), type of maternity delivery (P= 0. 999), and causes of preterm delivery (P = 0. 770). Conclusion: The most important factor in reducing infant mortality is preventing preterm birth which requires more effective interventions on prenatal care and treatment of complications of pregnancy and childbirth. Prenatal levels of care programs, establishing neonatal intensive care centers, and appropriate premature neonatal care equipment are also necessary in preventing infant mortality.

Background and purpose: Identifying the pattern and causes of death and dealing with its etiological factors is one of the most appropriate strategies to increase life expectancy. In this study, we examined the epidemiological prevalence of death in older adults receiving home treatment using International Classification of Diseases (ICD-10). Materials and methods: In this descriptive cross-sectional study, 744 older adult death cases of over 60 years of age receiving home treatment in Tehran Dam Home Treatment Center, 2012-2016 were selected using census sampling. A researcher-made checklist was completed by reviewing the death certificates and other medical documents. Data analysis was carried out in SPSS V24. Results: The main causes of death were as follows: respiratory diseases (acute respiratory failure=65. 86%), gastrointestinal diseases (liver cirrhosis= 47. 5%), cardiovascular diseases (hypotension= 53. 33%), neurological diseases (stroke= 100%), parasitic infectious diseases (septic shock= 85. 48%), cancer (liver cancer= 84. 62%), endocrine, nutritional and metabolic diseases (hypoglycemic coma= 66. 7%), and urogenital diseases (renal failure= 97. 85%). Conclusion: In population studied cardiovascular disease, respiratory and infectious-parasitic diseases were the main causes of death. Necessary care efforts are expected from aged people, their family, and the authorities to reduce the rate of death rate due to the above diseases.