Journal of Mazandaran University of Medical Sciences
Year:2023 | Volume:33 | Issue:224 |Papers Count:13

Background and purpose: Post-traumatic stress disorder (PTSD) is a psychotic disorder that occurs in people who have faced with various types of stressors. However, the efficacy of drug and psychotherapy methods, even in combination is still low. Therefore, complementary treatments are being researched. The relative improvement of PTSD has been observed with the use of Serotonin Selective Reuptake Inhibitors (SSRIs). The effect of exercise has also been determined in improving physical and mental health. But the appropriate exercise intensity is still in question. Therefore, the aim of this study was to investigate the effect of intense exercise, fluoxetine, and their combined treatment on behavioral, molecular, and cellular damages caused by a standard model of PTSD. Materials and methods: Single prolonged stress (SPS) was used as a model to induce PTSD. Exercise (1 hour, 15 m/min) was planned for five days per week and fluoxetine (10 mg/kg/day) dissolved in drinking water was administered for four weeks. After performing the anxiety test, the animals were killed under deep anesthesia and blood samples were collected to measure IGF-1 serum levels by ELISA method and prefrontal cortex was frozen to measure apoptotic factors by RT-PCR method. Results: SPS rats showed increased anxiety levels and decreased serum IGF-1 levels. Increased Bax and Caspase-3 mRNA expression, and decreased Bcl2 mRNA expression were found in the prefrontal cortex. Exercise, fluoxetine, and their combined intervention increased IGF-1, decreased the expression of pro-apoptotic factors, and increased the expression of anti-apoptotic factors. The results showed that the combined intervention of exercise and fluoxetine could reduce the anxiety caused by SPS. Conclusion: Considering that fluoxetine was more effective in comparison with high-intensity exercise, it is clear that in the groups that were affected by both interventions,fluoxetine played a more significant role.

Background and purpose: Electroconvulsive therapy (ECT) is commonly used in the treatment of psychiatric patients. However, it may cause cognitive disorders in patients undergoing the procedure. The aim of this study was to investigate the effect of memantine on the alleviation of cognitive impairments in patients undergoing ECT. Materials and methods: In this triple-blind clinical trial, 60 patients with depression phase of unipolar or bipolar non polycystic disorder were randomly divided into two groups of 30. In the treatment group, the patients received memantine for the whole period of treatment starting 24 hours before ECT (starting dose 10 mg/day, increased to 20 mg/day within one week) and continuing until the sixth session of ECT. In the control group, the patients received the placebo. The cognitive performance of patients was assessed using the Mini Mental Status Examination (MMSE) and the Addenbrooke's Cognitive Examination (ACE) 24 hours before the first ECT session, 24 hours after the sixth ECT session, and one month after the end of the ECT sessions. The study lasted 1. 5 years. Results: The MMSE score at the end of the study period (one month after the completion of ECT) in the memantine group was significantly higher than the control group (P=0. 008). However, there was no significant difference between the scores of ACE-R between the two groups after ECT. No significant relationship was found between the two groups in any of ACE-R items. Conclusion: According to the MMSE test, it seems that memantine reduces cognitive disorders in patients receiving ECT, but this finding was not observed in ACE-R.

Background and purpose: Many obese people have different psychological symptoms such as anxiety, depression, emotional regulation problems, etc., food addiction is also another psychological problem associated with obesity. In this research, for the first time, we investigated the effect of mindfulness-based stress reduction (MBSR) treatment on anxiety, depression, difficulty in emotional regulation, and food addiction in obese people. Materials and methods: In this clinical trial, 40 obese women were selected from urban health centers in Kashan, 2018. They were recruited using purposive convenience sampling. They were then randomly divided into an intervention group (MBSR, n=20) or a control group (educational session without any treatment, n=20). The MBSR was implemented according to the Kabat Ziin protocol during weekly sessions of 90-minute for eight weeks. The participants were evaluated at pre-test, post-test and three-month follow-up using the anxiety, stress, depression scale (DASS-21), difficulty in emotion regulation scale (DERS), and the Yale food addiction scale (YFAS). Data analysis was performed applying repeated measures ANOVA in SPSS16. Results: The intervention group was found with a significant reduction in the levels of anxiety (P<0. 01), depression (P<0. 000), difficulty in emotional regulation (P=0. 02), and severity of food addiction (P=0. 003) compared to the control group at post-test. At follow-up, we observed significant reduction in the levels of anxiety, depression, and food addiction (P=0. 003), but emotion regulation did not show a significant reduction compared to the control group (P>0. 05). Conclusion: Mindfulness-based stress reduction treatment could be considered as a part of comprehensive medical care for obese people.

Background and purpose: Metabolic syndrome is characterized by a cluster of symptoms including insulin resistance, blood pressure, abdominal obesity, defects in glucose metabolism, and dyslipidemia. Considering the increasing prevalence of cardiovascular diseases and metabolic syndrome, the aim of the present study was to investigate the relationship between metabolic syndrome and its criteria with cardiovascular diseases. Materials and methods: The present study was a case-control study that utilized the results of the enrollment phase of the Tabari cohort study. The case group (304 individuals) was randomly selected from participants with cardiovascular diseases (564 individuals). The control group (304 individuals) was randomly selected from among other participants who were matched by age and sex. The comparison of variables between the two groups was done using the chi-square test. Logistic regression test was used to adjust the effect of confounding variables. Results: Patients with metabolic syndrome were 69. 1% (210) in the case group and 55. 6% (169) in the control group (P=0. 001). The results of the univariate regression test showed that the chance of developing metabolic syndrome in people with cardiovascular diseases was 1. 755 times more than people without cardiovascular diseases (95% CI: 1. 280-2. 418, and P=0. 01). Among the diagnostic criteria of metabolic syndrome, the chances of high blood pressure, high triglyceride levels, and decreased HDL were significantly higher in the case group compared to the control group. Conclusion: The risk of metabolic syndrome is significantly higher in people with cardiovascular diseases compared to the ones without cardiovascular diseases. After adjusting for confounding factors, we found a significant difference between triglyceride level and blood pressure in the two groups.

Background and purpose: The risk of hypertension is increased as people get older. Hypertension and overweight/ obesity are highly prevalent in Iranian older adults and there are limited studies on the association between high blood pressure and visceral fat in this population. This research was conducted to evaluate the correlation between hypertension and visceral fat in older adults. Materials and methods: This case-control study was carried out using the records of people aged ≥,60 years who enrolled at Phase II of the Amirkola Health and Ageing Project (AHAP). People with hypertension (case group) and those without hypertension (control group) were matched for age and gender. Physical activity was measured using the Physical Activity Scale for Elderly. Visceral fat level was measured by a density meter device. Results: Out of 700 senior adults, half were found with hypertension. No significant difference was observed between the two groups in age (P=0. 684), body shape index (P=0. 691), and physical activity (P=0. 308). But, a significant difference was observed in mean waist circumference (P<0. 001), body mass index (P<0. 001), waist circumference to weight ratio (P<0. 001), and visceral fat (P<0. 001) between the two groups. There was a significant positive correlation between blood pressure and the levels of visceral fat, body mass index, waist circumference, and waist to height ratio in older males and females. Body mass index in male (P<0. 001, AUC=0. 710) and visceral fat level in female participants (P<0. 001, AUC=0. 626) were considerably correlated with hypertension. Conclusion: This study revealed a significant direct correlation between blood pressure and visceral fat level, body mass index, waist circumference, and waist to height ratio in older male and female population. Body mass index in male and visceral fat level in female older adults were strongly associated with hypertension.

Background and purpose: Investigation for an accurate, reliable, and non-invasive method for assessing volume responsiveness in septic shock patients is of high priority in the emergency department. Carotid artery Doppler sonography can be easily performed at the bedside. Therefore, this study used carotid Doppler sonographic parameters to determine and evaluate the need for volume in patients with septic shock. Materials and methods: The present single-center, prospective, observational study was performed on all patients with septic shock admitted to emergency department during the study period. Vital signs, diameter of the inferior vena cava (IVC), and the carotid Doppler peak velocity (CDPV) were evaluated on arrival and two hours after resuscitation. Data description and analysis were done using SPSS. Results: Forty-four patients enrolled in this study, of which 30 (68. 2%) were men. The average age of these patients was 62. 55±, 17. 91 years. The findings indicated a statistically significant increase in IVC min (P=0. 016), CDPV max (P=0. 001), and Δ, CDPV (P<0. 0001) in patients after two hours of treatment. Conclusion: Carotid Doppler sonographic parameters can be implemented, as a dynamic criterion, to determine the fluid responsiveness in patients.

Background and purpose: This study investigated the relationship between oral health related quality of life and hyposalivation and dry mouth in patients with chronic renal failure (CRF) undergoing hemodialysis. Materials and methods: This descriptive-analytical study was conducted in 200 patients with CRF undergoing hemodialysis attending the dialysis department in Sari Imam Khomeini Hospital, 2021. Patients completed oral health-related quality of life questionnaires (OHIP-14) with additive and simple count assessment methods. To diagnose dry mouth, unstimulated saliva was collected and patients were asked nine questions, of which five positive answers indicated dry mouth. Data analysis was done in SPSS V18. Pearson's or Spearman's correlation coefficient were applied to investigate the association between quality of life score and unstimulated salivary flow, and t-test or Mann-Whitney test were used to compare the quality of life scores between the groups with and without dry mouth. Results: Hyposalivation was observed in 66 patients (33%). The OHIP-14 score was significantly higher in both additive and simple count methods in patients with dry mouth and hyposalivation (P<0. 05). Comparing different variables, the findings showed that 66. 7% of the patients with hyposalivation were older than 58 years of age (P=0. 007). In addition, 60. 6% of patients with dry mouth had diabetes (P=0. 01). Conclusion: Dry mouth and hyposalivation reduce the quality of life in patients with CRF undergoing hemodialysis. Also, dry mouth and hyposalivation were relatively common problems in these patients. The treatment of these problems is necessary because of their impact on patients' quality of life.

Background and purpose: Psoriasis is a systemically pathogenic immune-mediated, chronic inflammatory disease that mostly affects the skin. Ocular diseases, which are frequently nonspecific or just slightly bothersome in psoriasis, are not well-known. This study investigated ocular manifestations in patients with psoriasis. Materials and methods: This cross-sectional study was conducted at Bu-Ali Sina hospital in Sari, Iran. Seventy-five patients with psoriasis matched by age and sex with 75 non-psoriatic controls were examined. Dermatology life quality index (DLQI) and psoriasis area and severity index (PASI) scores were calculated for every patient with psoriasis. Ocular surface disease index (OSDI) was measured in both groups. We did a slit-lamp examination, Schirmer I test, tear breakup time (TBUT) and fundoscopy in both groups. Results: The mean age of patients was 40. 11, 13. 88 years. The most common findings on our examinations were conjunctival hyperemia (38%), blepharitis (36%), MGD (33%), and pinguecula (26%). MGD and low TBUT were more common in patients with higher PASI and DLQI scores. OSDI score was also higher in patients with psoriasis. Conclusion: Ocular surface conditions such as dry eye were more common among the participants and were correlated with duration and severity of the disease. Therefore, psoriasis patients should get frequent and routine eye exams to detect ocular disorders quicly and avoid their unintended effects.

Background and purpose: Ventilator-associated pneumonia (VAP) is of special importance among nosocomial infections. We aimed to study the bacterial profile of VAP and their drug susceptibility pattern among intensive care unit patients at teaching hospitals affiliated with Mazandaran University of Medical Sciences. Materials and methods: In this retrospective cross-sectional study, the records of patients in the intensive care unit with ventilator-associated pneumonia were reviewed. After the growth of the bacteria, the colony identification of the grown bacteria were done based on microbiological and biochemical standard tests. To investigate the antimicrobial susceptibility pattern of isolates, the disk diffusion method was used according to the CLSI guidelines. Results: Out of 107 patients, 14 (13%) had a history of hospitalization over the last three months. The most common underlying diseases were ischemic heart disease (IHD), hypertension, and diabetes. The most common causes of hospitalization included cardiac diseases, COVID-19, and sepsis. The most common microorganism isolated was Enterobacter (23. 4%), and the least abundant microorganisms were Proteus (n=1) and Staphylococcus saprophyticus (n=1). In general, colistin was the most sensitive among the examined gram-negative organisms. Conclusion: Identifying the pattern of antibiotic resistance and the risk factors for ventilatorassociated pneumonia are effective in delivering more efficient treatments and reducing the complications of this disease. Local epidemiological data should be collected at all centers as this information guides the initial empirical treatment with antibiotics, thereby preventing the development of more resistant strains. All these measures will reduce the morbidity and mortality of ventilator-associated pneumonia.

Background and purpose: Adverse drug reaction (ADR) is one of the main causes of mortality and morbidity and can contribute to high costs in healthcare system of a country. This study was conducted to evaluate ADRs in the Food and Drug deputy at Mazandaran University of Medical Sciences. Materials and methods: This retrospective descriptive study was carried out after collecting the reports of yellow cards sent to the Center for Registration and Investigation of Adverse Drug Reaction in the Food and Drug Deputy of Mazandaran and the reports registered in the online system for registering medical complications and errors in 2019-2021. We analyzed data, including the frequency of the drugs with side effects, the frequency of routs of administration, number of reports per year, patient characteristics (gender and age), as well as the frequency of the organs damaged, and the reporters. Results: A total of 2122 reports of adverse drug reactions were submitted to the Adverse Drug Reactions Center at Mazandaran Food and Drug Department. Nurses reported 52. 78% of the side effects and 44. 82% of the ADRs were seen in women. Injectable drugs were found with high rate of ADRs (87. 40%) and the most prevalent side effects were associated with skin and hair disorders (28. 07%). Antiinfective agents were the most common drugs that caused ADR (47. 10%) and Vancomycin was found to be more prevalent than other drugs. Conclusion: Adverse drug reactions were reported at a good level in Mazandaran province. It is believed that training the medical staff about pharmacovigilance and appropriate reporting, will bring us closer to world standards.

Background and purpose: Depth perception (stereopsis) is the ability to perceive depth in visual space through sensory integration of retinal images in both eyes and is achieved through binocular perception in specific visual pathways in the cerebral cortex. Medical students use a variety of diagnostic tools during their training, and a lack of normal stereoacuity can affect their professional performance. Understanding the appropriate stereopsis also plays a crucial role in their future careers. The purpose of this study was to determine stereopsis using the Titmus test in subjects with and without refractive errors. Materials and methods: In this cross-sectional study, 115 students at Mazandaran University of Medical Sciences who met the inclusion criteria were randomly selected. Based on the presence or absence of refractive errors through retinoscopy, they were divided into symptomatic and asymptomatic groups. The stereopsis was measured by the Titmus test. Data were analyzed in SPSS V 21, and the frequency of stereoacuity was reported. Results: A total of 115 people enrolled in this study. Males accounted 55. 7% (n=64) of the subjects and 44. 3% (n=51) of the subjects were females. The mean age of male and female participants were 25. 20±, 1. 88 and 24. 15±, 1. 79 years, respectively (P>0. 05). There were 40 (34. 8%) students with refractive errors and 75 (65. 2%) without refractive errors. The mean values for stereopsis in symptomatic and asymptomatic subjects were 42. 90±, 29. 59 and 29. 24±, 12. 96 seconds/arc, respectively(P=0. 001). These values in males and females were 32. 12±, 20. 73 and 36. 33±, 21. 85 seconds/arc, respectively (P=0. 293). The mean test time was 57. 75±, 18. 43 and 56. 0±, 18. 49 seconds in symptomatic and asymptomatic subjects (P=0. 629), and 54. 45±, 17. 82 and 59. 31±, 18. 94 seconds in males and females (P=0. 160), respectively. Conclusion: Titmus stereo test was found to be an effective test for evaluating the depth perception of symptomatic and asymptomatic subjects. There was no difference in the stereopsis between males and females in this study.

Background and purpose: Human health is negatively affected by increase in concentration of carbon dioxide in indoor air due to the lack of proper ventilation. The aim of this study was to remove carbon dioxide from a closed space using sodium hydroxide nanofluid and determining the effect of absorbent concentration, carbon dioxide concentration, and titanium dioxide nanoparticles. Materials and methods: The experiments were conducted in a closed chamber on a laboratory scale. An air suction pump was connected to the absorption reactor and the carbon dioxide measuring device was installed inside the chamber. By injecting carbon dioxide gas inside the chamber, different concentrations in the range of 500, 2000 and 5000 ppm were created. Sodium hydroxide absorbent solution at 0. 1, 0. 2, and 0. 4% were examined. Titanium dioxide nanoparticles (0. 008%) and surfactant (0. 003%) were used to prepare nanofluids. The absorption fluids’,pH, electrical conductivity, and total inorganic carbon (TIC) were measured before and after carbon dioxide absorption. Results: By using 0. 4% sodium hydroxide solution containing 0. 008% titanium dioxide nanoparticles, the carbon dioxide removal efficiency at 500 and 5000 ppm were 72% and 44%, respectively, that were higher than the solution without nanoparticles (20% and 10%, respectively). At 5000 ppm carbon dioxide, increasing the concentration of absorption solution from 0. 1 to 0. 4% doubled the removal efficiency. The average amount of total inorganic carbon (TIC) in nanofluids increased by about 20% compared to the base fluids. The average reduction of EC in nanofluid was about 25% higher than the base fluid. The average reduction in pH value was less than one unit. Conclusion: Sodium hydroxide nanofluid containing 0. 008% of titanium dioxide nanoparticles is effective in removing carbon dioxide from the air.

Background and purpose: Hypoxia can lead to body function impairment. It is linked to the pathology of acute mountain sickness, cardiovascular disease, and stroke. Colchicine, an antiinflammatory drug, is used chiefly in treatment of gout, but it is also valuable in other inflammatory conditions. Preliminary data shows that colchicine has beneficial effects on COVID-19. Nothing is known about the protective effect of this drug against hypoxia-induced lethality in mice. Materials and methods: Protective effects of colchicine against hypoxia-induced lethality in mice at 0. 5, 1, and 1. 5 mg/kg, P. O. were evaluated in three experimental models of hypoxia. Results: Colchicine showed good activity in some models. In the circulatory model, at 0. 5 mg/kg, it significantly prolonged mice survival time for 4. 5 min (P<0. 05). At this dose, it showed similar activity to propranolol 30 mg/kg which was used as the positive control. At 1. 5 mg/kg, it was more effective than propranolol (P<0. 0001). In the haemic antihypoxic model, colchicine at 1 mg/kg, significantly increased survival time and showed the same activity as propranolol (P>0. 05). In the asphyctic model, colchicine did not show any activity. Conclusion: Colchicine showed good protective effects against hypoxia in circulatory and haemic models where the drug at 1. 5 mg/kg, was more effective than the positive control, propranolol at 30 mg/kg.