Journal of Mazandaran University of Medical Sciences
Year:2023 | Volume:33 | Issue:225|Papers Count:25

Background and purpose: Amikacin (AMK) is a commonly used aminoglycoside antibiotic with rapid onset of action, low cost, and high antibacterial efficacy. However, its long-term use has been associated with kidney toxicity, which is a significant concern for patients. Hence, the present study was designed to evaluate the protective effect of pentoxifylline (PTX) against amikacin-induced nephrotoxicity in male mice. Materials and methods: Forty-two Balb/c mice were allocated to seven groups as follows: I, control,II, AMK (500 mg/kg/day),III to V, received AMK plus PTX (50, 100, 200 mg/kg/day),VI, AMK plus vitamin C (500 mg/kg/day),and VII, PTX alone (200 mg/kg). All the treatment was done intraperitoneally for 15 consecutive days. Then, kidney tissues were separated and several factors including level of reactive oxygen species (ROS), protein carbonyl (PrC), lipid peroxidation (LPO), antioxidant content (glutathione), nitric oxide (NO) production, and expression of apoptosis-related genes (Bax and Bcl-2) were evaluated. Also, evaluation of biochemical parameters (BUN and Cr) as well as histopathological changes were performed. Results: Administration of AMK led to significant changes in tissue pathology and the level of BUN and Cr. AMK significantly promoted ROS, LPO, PrC, and NO levels in kidney while it reduced GSH storage. Also, AMK injection led to significant increase in Bax/Bcl2 expression ratio. PTX alleviated oxidative stress markers and nitric oxide induced by AMK in kidney tissue. Moreover, AMK recovered biochemical and pathological changes associated with AMK. PTX treatment decreased the Bax expression and increased the expression of Bcl-2 significantly. Conclusion: Pentoxifylline showed protective effects against amikacin-induced nephrotoxicity which may be attributed to its antioxidant activity and anti-apoptotic effects. So, it can be considered as a therapeutic approach against toxic effects of amikacin in kidney tissue.

Background and purpose: Post-traumatic stress disorder (PTSD), a type of psychiatric disorder that occurs after exposure to traumatic events, is associated with anxiety and abnormality in the activity of hypothalamic-pituitary-adrenal axis and cognitive functions. Physical activity can improve symptoms of somatic and neuropsychiatric disorders,however, appropriate exercise intensity and duration are still in question. In the present study, the effects of high-intensity exercise on anxiety-like behaviors, fear extinction, serum insulin-like growth factor (IGF-1), brain-derived neurotrophic factor (BDNF), and expression of apoptosis-related genes were investigated in the prefrontal cortex of the rat PTSD model. Materials and methods: In this experimental study, single prolonged stress (SPS) was used to induce PTSD in adult male Wistar rats. After 10 days, the animals in the exercise groups were subjected to high-intensity treadmill exercise (20 m/min, 5 days/week) for four weeks. Next, anxiety-like behaviors and fear extinction were examined using open field and shuttle box tests, respectively. Thereafter, serum IGF-1 and brain BDNF were measured by ELISA kits,and expression of Bax, Bcl-2, and caspase-3 in the prefrontal cortex were measured by real-time PCR. Results: SPS rats showed increased anxiety and decreased fear extinction, serum IGF-1, and prefrontal BDNF compared to the control animals. In addition, SPS induced apoptosis by an increase in Bax and caspase-3 and a decrease in Bcl-2. High-intensity exercise reduced apoptosis and increased serum IGF-1 significantly (P<0. 05). Conclusion: High-intensity exercise decreases anxiety-like behaviors by increasing serum IGF-1 and inhibiting apoptosis in the prefrontal cortex of PTSD rats.

Background and purpose: Hypoxia can lead to body function impairment and is linked to the pathology of acute mountain sickness, cardiovascular disease, and stroke. Hypoxia causes oxidative stress involving production of reactive oxygen species (ROS). Heracleum persicum and Boswellia serrata (Kundur) are well-known medicinal plants with high level of antioxidant activities and therapeutic potential use against COVID-19. However, nothing is known about antihypoxic activity of these plants. Materials and methods: Protective effects of H. persicum fruit and Kundur resin against hypoxia-induced lethality in mice were evaluated by three experimental models of hypoxia including asphyctic, haemic, and circulatory using two administration methods, intraperitoneal (i. p. ) and gavage. Results: H. persicum extract (i. p. ) was dose dependent and showed very good activities in all antihypoxic models. In circulatory, asphyctic, and haemic models, extarcts at 3. 90, 7. 81, and 31. 25 mg/kg showed the same activities of propranolol (30 mg/kg) which was used as positive control (P>0. 05). In circulatory model, Kundur (by gavage) at 62. 5 mg/kg showed the same activity as positive control (P>0. 05). H. persicum extract in the form of i. p., and Kundur by gavage were more efficient than the other forms. Conclusion: Extracts showed very good protective effects against hypoxia in all the models. Even in low doses, they were able to show the same activity as positive groups. It seems that these plants have a good potential for treating hypoxic conditions such as COVID-19.

Background and purpose: Acrylamide is a chemical compound that is widely used in the production of paper, paint, and other industrial products. Food and cigarette smoke are primary sources of exposure to acrylamide. Betaine is a native compound with antioxidant properties and has also been reported as a protective agent against tissue damages induced by some toxicants. This study aimed to evaluate the possible effectiveness of betaine against the damage caused by acrylamide in brain. Materials and methods: In this experimental study, 28 male rats were randomly divided into four groups. The first group was considered as the control group. Group 2 received acrylamide (50 mg/kg, ip). Group 3 received the diet containing 2% betaine in addition to acrylamide. Rats in group 4 received diet containing 2% betaine. At the end of the experimental period (the eleventh day), brain tissue was sampled for biochemical and histopathological evaluation. ANOVA and Bonferroni tests were utilized to compare the means of biochemical data, and Kruskal-Wallis and Mann-Whitney tests were employed to investigate histopathological data. Calculations were conducted using SPSS/PC V21. Results: In the group receiving acrylamide, significant reduction in catalase and superoxide dismutase and significant increase in proteins carbonyl groups and malondialdehyde were observed in comparison to the control group (P<0. 05). Hyperemia, microgliosis, and ischemic cell changes in the brain tissue of the group receiving acrylamide increased significantly compared to the control group (P<0. 05). Administration of betaine in acrylamide+betaine group caused an increasing trend of catalase and superoxide dismutase relative to group 2 in a manner that were comparable with those of the control group. Likewise, betaine administration in acrylamide+betaine group significantly (P<0. 05) reduced the severity of ischemic cell changes and non-significantly reduced hyperemia and microgliosis compared to the group receiving acrylamide. Conclusion: Betaine administration could be beneficial to oxidative indices alterations and could improve tissue damage induced by acrylamide in brain of rats.

Background and purpose: Cisplatin is one of the widely used chemotherapeutics, that directly affects the ovaries and uterus leading to infertility. This study aimed to investigate the effects of inositol and vitamin C on cisplatin-induced damage to ovarian follicles and uterine histopathology. Materials and methods: Fifty-six adult Wistar female rats were divided into eight equal groups (N=7) including negative control (oral normal saline/intraperitoneal normal saline), positive control (normal saline/cisplatin), T1 (vitamin C/cisplatin), T2 (inositol/cisplatin), T3 (vitamin C and inositol/cisplatin), T4 (vitamin C/normal saline), T5 (inositol/normal saline), and T6 (vitamin C and inositol/normal saline). The vitamin C and inositol were administered orally for 21 days. Cisplatin was injected intraperitoneally on the 15th day (7 mg/kg). On the day 22, the animals were euthanized, the uterus and ovaries removed, then the number of ovarian follicles and the uterine histopathology were examined. Results: After cisplatin treatment, the number of healthy ovarian follicles (primordial and antral) significantly decreased (P<0. 05) compared to the negative control group. However, all of the atretic follicles increased compared to the negative control (P<0. 05). Treatment with vitamin C and inositol increased the number of healthy follicles, effectively reduced the number of atretic follicles, and improved the damage induced by cisplatin in the uterine tissue. Conclusion: Treatment with vitamin C and inositol has a protective effect on the ovaries and uterus against the toxicity caused by cisplatin.

Background and purpose: The investigation of low-frequency electromagnetic fields (EMF, 50Hz) reveals their destructive effect on metabolic activity of cells. Due to the sensitivity of the fetal period, which is associated with the differentiation, the probability of organ damage is high. So the purpose of this research was to investigate histopathological damages to liver of rat offspring. Materials and methods: Fifteen female rats after mating and pregnancy diagnosis were used. Pregnant mice were divided into three groups: 1. EMF group of rats were exposed to waves for 0. 5 hour daily during pregnancy,2. the Sham group was placed inside the device under the same conditions of EMF group without radiation,and 3. control group. At the end of the pregnancy period (21 days), infants were divided into three groups according to their mother's grouping and at the end of the infancy period (28 days), tissue sampling of infant livers was done. Then the histopathological data of liver tissue were statistically analyzed. Results: In the EMF group, newborn babies exhibited stable histopathological changes in their liver tissue, with necrotic and degenerative areas increasing by 42% and 2. 5 times, respectively, compared to the control and Sham groups. These differences were statistically significant (P≤0. 05). Also, a numerical increase in hyperemia lesions and liver tissue inflammation was observed in this group compared to the control and Sham groups. Conclusion: Our results showed that the low-frequency EMF in the pregnancy period of mothers has a significant effect on tissue lesions of the liver of newborn rats.

Background and purpose: Today, cancer is considered as the second cause of death in the world. Often, the treatment of all types of cancer is very complicated. The discovery of new anti-cancer drugs with high effectiveness, low toxicity, the ability to select normal cells from cancerous cells, and low cost is one of the concerns of the world's pharmaceutical communities. Nowadays, the use of natural compounds based on their synergistic effects has opened a new therapeutic horizon in the management of different types of cancers. The aim of this study was to investigate the synergistic effects of peiminine and hyperthermia therapy on the induction of apoptosis in MCF-7 cell line. Materials and methods: In the present experimental-laboratory study, after culturing MCF-7 cells in 96-well plates, they were treated with peiminine (5. 12 µg/ml for 24 h) and hyperthermia (410C for 1 h) independently and simultaneously. Then the cell viability rate, apoptosis percentage, ROS production rate, LDH release rate, and caspase 8 and 9 activity level were measured. Results: The results of the present study showed that peiminine and hyperthermia therapy caused a significant decrease in cell viability as well as a significant increase in the percentage of apoptosis, ROS production, and LDH release compared with the control group. By measuring the activity of caspase 8 and 9, it was determined that peiminine induced apoptosis through both mitochondrial and extracellular pathways. It was also found that peiminine and hyperthermia therapy, in combination, had synergistic antiproliferative effects. Conclusion: According to the results of the present study, it seems that peiminine, as a natural product, when used in combination with hyperthermia therapy has synergistic antiproliferative and apoptosis-inducing effects. This suggests that it can be used as a complementary method in cancer treatment.

Background and purpose: Uterine atony is responsible for 75-90% of postpartum hemorrhage, which will increase the probability of maternal mortality if proper measures are not taken to correct it. The aim of this study was to determine the therapeutic effect of tranexamic acid along with oxytocin in controlling postpartum hemorrhage. Materials and methods: This clinical trial study was performed on 142 pregnant women referring to Imam Sajjad Hospital in Yasouj for delivery in 2019-2020. Patients were randomly divided into two groups. The intervention group (71 people) received an ampoule of oxytocin at the rate of 40 units per liter of Ringer's serum and an ampoule of tranexamic acid at the rate of one gram per 10 cc of normal saline in a slow intravenous manner for 1 minute. The control group (71 people) received 40 units of oxytocin in one liter of serum and 10 cc of normal saline as a slow intravenous infusion for 1 minute. Then, the bleeding volume was evaluated based on the weight of gas consumed, the volume of blood collected, and the number of red blood cells received in both groups. Descriptive statistics of ratio comparison tests (chi-square) and t-test were used for data analysis. Results: The decrease of hemoglobin in the intervention group was significantly lower than the control group (P=0. 007). The average change in gas weight at the end of the operation was higher in the control group (602. 7±66. 8) compared to the intervention group (571. 7±81)(P=0. 014). Also, the average bleeding volume and the number of blood bags received in the control group were higher than the intervention group, however, no significant relationship was observed (P>0. 05). Conclusion: Administering tranexamic acid together with oxytocin, in the case of uterine atony, may be more effective than oxytocin alone in controlling postpartum bleeding during cesarean section.

Background and purpose: Infertility is defined as the inability to conceive after 12 months of regular coitus. Anovulatory processes are the most common cause of infertility in women. The aim of this study was to compare the efficacy of combination treatment of clomiphene citrate (CC) and letrozole versus letrozole alone for ovulation induction and pregnancy rate in infertile women with polycystic ovarian syndrome (PCOS). Materials and methods: This is a single-blind, controlled trial study. A total of 102 infertile PCOS women were randomly divided into two groups. Group one (n=51) received 100 mg CC plus 5 mg letrozole daily on cycle days 3-7 for a single treatment cycle and group two (n=51) received 5 mg letrozole daily on cycle days 3-7 for a single treatment cycle. When at least one follicle reached a diameter of 18-19 mm, the patients received human gonadotropin hormone (5000 U-IV injection). The couples had regular intercourse, 2-3 times a week, as they had been instructed. Results: The number of follicles with a diameter of 14 mm was significantly higher in women who received the combination treatment of letrozole and clomiphene compared to the ones who received letrozole treatment (P=0. 04). There were no statisticaly significant differences in the number of 18 mm follicles (P=0. 07), mean endometrial thickening (P=0. 37), clinical pregnancy rate (P=0. 99), ongoing pregnancy rate (P=0. 59), multiple pregnancy rate (P=0. 99), and live birth (P= 0. 99) between the two groups. Conclusion: According to our study, the combination treatment of letrozole and CC is more effective than letrozole and can be used as the first-line therapy for infertility in women with PCOS. Moreover, the cost and risk of this treatment may be lower than other induction ovulation treatments.

Background and purpose: Thirst is one of the most common problems in patients undergoing hemodialysis, which stimulates the patient to consume more fluids, causes weight gain between two dialysis, reduces quality of life, and leads to many other problems. Therefore, due to the necessity of using thirst management methods, the aim of this study was to determine the effect of ice chip containing menthol on the thirst of patients undergoing hemodialysis. Materials and methods: In this clinical trial study, 60 patients of Birjand dialysis centers were selected considering study criteria using convenience sampling. The patients were randomly assigned to the control and experimental groups. The experimental group consumed 12 pieces of ice chips containing menthol every day for one week and the control group did not receive any intervention. Questionnaires of intensity of thirst, discomfort of thirst, duration of thirst, and dry mouth were completed before each dialysis session during the week before the intervention and during the intervention, and the volume of fluids consumed was measured and recorded in a daily checklist. Data were analyzed using SPSS V15 applying independent t-test, paired t-test, x2 and Fisher exact test at the significance level of P<0. 05. Results: The results showed that in the experimental group, the mean score of duration of thirst, intensity of thirst, dry mouth, thirst discomfort, volume of fluids consumed, and number of thirsts had a significant decrease after the intervention compared to before it (P= 0. 0001). The mean score changes of thirst duration, thirst intensity, dry mouth, thirst distress, fluid consumption, and number of thirsts in the experimental group were significantly higher than the control group (P=0. 0001). Conclusion: Considering the effect of ice chip containing menthol on the thirst of dialysis patients, the use of this simple, applicable, and low-cost method is recommended for thirst management.

Background and purpose: Public vaccination was highly recommended during the COVID-19 pandemic. The lack of evidence-based data made inflammatory bowel disease (IBD) patients hesitant to receive the vaccine. In this study, clinical and laboratory outcomes of COVID-19 vaccination were investigated in patients with IBD. Materials and methods: This retrospective study was conducted on patients with IBD who referred to gastroenterology clinics across Sari during 2021-2022. Patients' information including demographic data and laboratory parameters were recorderd. Clinical outcomes of IBD based on the partial Mayo score in ulcerative colitis and the Harvey-Bradshaw index in Crohn's were compared before vaccination and within three months after receiving the second vaccine. Results: A total of 111 patients with IBD, including 100 ulcerative colitis patients and 11 Crohn's patients met the inclusion criteria for the study. The two groups were matched for distribution of age, gender, and disease extent. In addition, there was no significant difference between the groups in COVID-19 infection frequency, COVID-19 severity, type of vaccines received, and vaccine injection frequency. No significant differences were observed in clinical outcomes and laboratory parameters between the patients before being vaccinated and after receiving the second dose of vaccine. There were no changes in the type of IBD drugs within three months after getting the second vaccine, except for steroid prescription increase in ulcerative colitis patients (4% vs. 10%, P<0. 01). Moreover, a statistically significant correlation was found between steroid necessity and partial Mayo score (r=0. 658, P<0. 001). Conclusion: Receiving at least two doses of COVID-19 vaccines did not change the clinical outcomes and laboratory parameters of IBD patients. The results of this study are promising and can reduce possible concerns in IBD patients regarding the use of vaccines against COVID-19.

Background and purpose: The aim of the study was to determine the relationship between electrolyte disorders and disease severity in children with COVID-19 infection referred to Amirkola Children's Hospital. Materials and methods: We performed the cross-sectional study on children aged 1 month to 18 years with COVID-19 infection referred to Amirkola pediatrics hospital, Babol, Iran from March 2018 to July 2018. The level of serum of potassium, sodium, calcium, and fasting blood sugar were measured at the beginning of hospitalization in all study children. Severity of COVID-19 infection was evaluated with Pediatric Early Warning Score (PEWS). Data were analyzed using Chi-Square, ANOVA, and logistic regression tests. P-values of less than 0. 05 were considered significant. Results: Out of 160 children referred to the hospital during the study, 122 were selected. The most common electrolyte disorders were hyponatremia (42. 6%) and hypocalcaemia (16. 4%). No significant relationship was found between calcium (P=0. 30) and potassium (P=0. 12) disorders and severity of COVID-19 infection. There was a significant relationship between the sodium disorder and severity of COVID-19 infection (P<0. 001). Also, the results of the logistic test illustrated that after adjusting confounding variables (age and gender), children with hyponatremia experienced a higher chance of severe COVID-19 infection (OR: 6. 31. 00,CI: 2. 61, 15. 28,P<0. 0001). Conclusion: Hypernatremia and hypocalcaemia are the most common electrolyte disorders in children with COVID-19 infection. Hypernatremia was associated with increased chance of severe COVID-19 infection.

Background and purpose: Patients undergoing hemodialysis experience many problems, both physically and mentally, which lead to low quality of sleep, and subsequent changes in the quality of their life. In addition, dialysis adequacy plays a pivotal role in the quality of their life. Therefore, the present study was conducted to determine the relationship between dialysis adequacy and quality of life with the mediating effect of sleep quality. Materials and methods: A descriptive, analytical, correlational study was performed on 208 patients undergoing hemodialysis in medical education centers of Mazandaran using head count sampling. The implemented tools included demographic information checklist, WHOQOL quality of life questionnaires, Pittsburgh sleep quality (PSQI), and dialysis adequacy checklist. The data were analyzed using SPSS V22 and performing the statistical tests of t-test (comparing the mean of two groups), analysis of variance (comparing the mean of more than two groups), and Pearson correlation (to check the correlation between two quantitative variables). Multiple linear regression was used to identify factors affecting the score of dependent variables and to control confounding variables. Structural equation analysis was also used to investigate the relationship between dialysis adequacy and quality of life with regard to the mediating effect of sleep quality. Results: The mean and standard deviation of quality of life, sleep quality, and dialysis adequacy were 48. 43±17. 14, 5. 52±3. 46, and 1. 28±0. 30, respectively. Based on the results of correlation coefficient and structural equations, no statistically significant relationship was found between dialysis adequacy and quality of life (P=0. 114). There was a significant inverse relationship between dialysis adequacy and the score of sleep quality (a score of less than 5 is desirable) (r=0. 15, P=0. 034), so that the quality of sleep improved as the dialysis adequacy increased. There was a statistically significant and inverse relationship between sleep quality score and quality of life (r=-0. 53, P<0. 001) so that improvement in the quality of sleep contributed to the improvement in the quality of life. Conclusion: Sleep quality, as a mediator factor which is influenced by the adequacy of dialysis, affects the overall quality of life and improves the quality of life in dialysis patients.

Background and purpose: One of the possible factors for the continuation of hepatitis B infection in hemodialysis adults is the presence of hidden hepatitis B. Considering the risk of occult hepatitis B infection in people with immunodeficiency disorders, especially hemodialysis patients, the aim of this study was to investigate the frequency of occult hepatitis B among dialysis patients in Sari. Materials and methods: This cross-sectional descriptive research was conducted in Sari, 2018. Blood samples were taken from dialysis patients before dialysis. Then, HBV serology tests (HBs-Ab, HBs-Ag, HBV PCR, and HBc-Ab) were performed using ELISA method. Data analysis was done using SPSS V20. Chi-square test was used to find correlation between qualitative variables. Also, the differences were compared using independent t-test, and P<0. 05 was considered significant. Results: A total of 279 dialysis patients were investigated in this study. The chi-square test showed that there was no significant difference between the two groups in terms of gender (P>0. 05), but significantly, the majority of the studied patients had a previous history of diabetes and high blood pressure (P<0. 05). The findings revealed that there was no significant relationship between latent hepatitis B and demographic information (P>0. 05). Independent t-test showed that the average age of people with latent hepatitis B was significantly higher than the rest of dialysis patients. (P=0. 030). Of the patients, nine (3. 23%) had positive HBs-Ag, of whom seven were under treatment and two did not need any treatment. Despite two complete series of vaccination against hepatitis B, six patients (2%) with negative HBs-Ag and HBs-Ab were reported to have positive HBc-Ab. Two cases of them (0. 71%) were PCR positive, which were real latent hepatitis, and four others were recorded as old recovered hepatitis. Conclusion: The findings suggested that HBs-Ag was a necessary but not sufficient factor in patients with End-Stage Renal Disease (ESRD),therefore, it was recommended to evaluate HBc-Ab and to test PCR for positive cases.

Background and purpose: Given the importance of virtual education, either on its own or in conjunction with face-to-face education, the present study aimed to compare face-to-face and virtual education from the perspective of students of Mazandaran University of Medical Sciences along with investigating the factors affecting the effectiveness of these two educational methods in 2022. Materials and methods: In this cross-sectional analytical study, the opinions of students regarding the quality of face-to-face and virtual education were investigated. To compare the average scores, we used independent t-tests and analysis of variance (ANOVA). Moreover, the Pearson correlation test and linear regression were used to investigate the relationship between the teaching method and also the scores of face-to-face and virtual educations with quantitative independent variables, respectively. All analyses were performed using SPSS V22. Results: According to the results, the total average scores for face-to-face and virtual education were 68. 65±14. 65 and 55. 90±17. 39, respectively. Employment status, faculty, the number of face-to-face semesters, and the skill level in using equipment had a significant relationship with face-to-face education score. Also, marital status and the number of face-to-face semesters were significantly associated with the virtual education score ( P<0. 05 ). Conclusion: In this study, the average scores obtained by students in face-to-face education were higher compared to the scores obtained in virtual education. Due to the possibility of any emergency situation and disruption in face-to-face education at universities and educational institutions, it is expected to improve the quality of virtual education through a well-planned educational system.

Background and purpose: Mycotoxins are secondary metabolites of fungi that have carcinogenic effects. Ochratoxin A (OTA) is a highly toxic mycotoxin that can contaminate wheat grains and flour under various conditions of production, storage, and maintenance. Considering the carcinogenicity and mutagenicity of this toxin, it is necessary to monitor the contamination of wheat flour used in bakeries and to prevent this product from entering the bread supply chain. The aim of this study was to identify and determine the amount of OTA in wheat flour consumed by bakeries in Sari, during 2017 using high performance liquid chromatography (HPLC) method. Materials and methods: In this study, 30 samples of flour used in the preparation of lavash, barbari and sengak bread were collected from five different geographical areas of Sari (Mazandaran province) in 2017. The concentration of OTA was finally determined using HPLC device and through purification with an immunoaffinity column. Results: No concentration of OTA was observed in any of the tested samples. The results were in compliance with the mentioned reference values of OTA concentration in bakery products based on the Iranian National Standard Organization. Conclusion: Based on the results, the flour used in breads is safe in terms of OTA. This amount is in accordance with the permissible limits set by the Iranian National Standard Organization and is acceptable for consumption.

Background and purpose: Role modeling is defined as "a purposeful activity that demonstrates the knowledge, skills, attitudes, and behaviors that students should acquire. " This is an educational method suitable for the medical environment where students have the opportunity to observe their professors in action and behavior. All the teachers of medical sciences are diligent in training human resources, but developing a professional identity in medical students is a top priority which could help them to become good doctors. The purpose of this study was to explain the role modeling of teachers in professional identity formation of medical residents. Materials and methods: Sixteen medical residents, aged between 26 and 40 (male and female), participated in this qualitative content analysis study. The residents beloned to four major specialty groups including obstetrics and gynecology, surgery, internal medicine, and pediatric. Data were collected from four specialty hospitals of Tehran University of Medical Sciences through semi-structured in-depth interviews. Then the collected data were analyzed using conventional content analysis. Results: Data analysis showed four main categories of "access to the role of models" including ethical role modeling, professional role modeling, personality role modeling, and interpersonal interaction role modeling. These conceptualized categories explained that role modeling teachers created good opportunities for professional identity formation of medical residents. Conclusion: Based on the present study, role modeling is a combination of individual characteristics and professional patient care that is implicitly revealed in medical education. Excellence in role modeling requires showing superior clinical care, teaching skills, and strengthening the good personal characteristics of professors. More studies and effective interventions in empowering of medical teachers can help lifelong learning and create a positive learning environment in the formation of professional identity in medical students and residents.

Background and purpose: Laparoscopic cholecystectomy is known as the standard treatment for inflammatory diseases of the gallbladder. This surgical method causes complications in the patients. To prevent gastric aspiration during anesthesia, long fasting periods are considered for the patients before surgery, which itself leads to serious complications before and during surgery. Therefore, this study was conducted to investigate the effect of oral consumption of honey syrup on the patients' feelings of hunger and thirst before surgery, as well as the hemodynamic symptoms of laparoscopic cholecystectomy operations. Materials and methods: This study was conducted as a double-blind, randomized clinical trial on 68 patients who were candidates for laparoscopic cholecystectomy surgery. The prescription of honey water in the intervention group and placebo in the control group was twice a day (eight and two hours before the operation, each time 15 ml). In this study, the variables of hunger and thirst, blood pressure, and heart rate were evaluated and recorded. The data were analyzed using SPSS V22. Results: Oral consumption of honey beer syrup was effective on the feeling of thirst and hunger before surgery in the intervention subjects (P=0. 004 and P=0. 008, respectively). At different times, the average systolic and diastolic blood pressure and heart rate were not significantly different in the two groups (P>0. 05). Gender had a significant relationship with the average systolic and diastolic blood pressure and heart rate (P>0. 05). Conclusion: Oral consumption of honey syrup before surgery reduced the feeling of hunger and thirst in the patients.

Background and purpose: A pandemic can negatively affect both mental and social health. The aim of this study was to evaluate stress, anxiety, and sleep disorders experienced by dentists during COVID-19 pandemic. Materials and methods: This cross-sectional descriptive study was conducted on all dentists in Sari (290 dentists). Corona Disease Anxiety Scale and Pittsburgh Sleep Quality Index were used as questionnaires. Data analysis was conducted using SPSS V26. Results: A total of 126 dentists completed the questionnaires. The mean values of stress and anxiety score for general dentists and specialists were 12. 4 and 11. 5, respectively which were classified as mild level. There was no statistically significant relationship between sex, anxiety, and stress (P=0. 09 for general dentists,P=0. 13 for specialists). The prevalence of sleep disorders was 78% and 72% for general dentists and specialists, respectively. The mean value of sleep disorders was 6. 8 for general dentists and 6. 1 for specialists which was considered as low and inappropriate. There was no statistically significant relationship between sleep disorders and sex (P=0. 4 for general dentists,P=0. 9 for specialists). Conclusion: The dentists' stress and anxiety level was mild during the COVID-19 pandemic. Prevalence of sleep disorders was high and sleep quality was poor and unsuitable for both general dentists and specialists.

Background and purpose: Anxiety and depression are prevalent problems associated with chronic diseases, such as hemodialysis. It is possible to reduce the psychological problems of hemodialysis patients by detecting the needs of these patients. The present study aimed to determine the relationship between spiritual needs and the levels of anxiety and depression in hemodialysis patients. Materials and methods: The present study was conducted using descriptive correlational method. The statistical population of this study was comprised of 164 hemodialysis patients who referred to Shahrvand Kidney Diseases Center in Sari. They were included in the study by a convenience sampling method. Data collection tools included demographic information questionnaire, hospital anxiety and depression questionnaire (1983), and Büssing et al. emotional needs questionnaire (2010). Data were analyzed using SPSS V25 applying descriptive statistics of mean and standard deviation. Spearman's correlation coefficient and regression were performed to examine the relationship between variables. Results: A total of 164 people participated in this study. The mean score of spiritual needs of hemodialysis patients was 27. 62±10. 85. The results revealed a significant positive relationship between spiritual needs and all its subscales, and anxiety and depression (P<0. 05, r=0. 721 for anxiety, and r=0. 645 for depression). Also, religious and emotional subscales were the best predictive variables for anxiety,and religious and existential subscales were the best predictors of depression. Conclusion: Based on the observed relationship between spiritual needs, and anxiety and depression in hemodialysis patients, more attention should be paid to these needs and the factors exacerbating the conditions of hemodialysis patients. Also, more studies are required to gain a better understanding of their needs and to find ways to improve their conditions.

Background and purpose: The physical location of colleges is vulnerable to natural disasters and accidents. Therefore, it is necessary to develop a preparedness and response plan. The present study aimed to assess the readiness of accident risk management and passive defense in the Faculty of Nursing and Midwifery at Mazandaran University of Medical Sciences. Materials and methods: This study applied an action research approach. The data collection procedure was performed by evaluating the readiness of the faculties of the University of Medical Sciences in managing the risk of accidents and passive defense. Data were analyzed using the descriptive statistics of frequency, percentage, mean, and standard deviation. Then the results were discussed in the risk management and passive defense committee of the faculty. After several consecutive brainstorming sessions, the solutions were proposed in order to fix the weaknesses. Results: In the initial evaluation, the level of preparation in the faculty was considered to be low (˂39%). The possibility of fire and the vulnerability of the building in terms of structural safety were determined to be the most risky factors in the college. After improving the risk management process, the faculty's level of preparedness was determined to be average (40-60%). Conclusion: The current action research approach improved the safety of the college. No budget allocation for safety measures and the time-consuming communication process between different departments are the major obstacles to achieving optimal safety in educational spaces.

Background and purpose: The prevalence of type 2 diabetes mellitus has increased along with the global epidemic of obesity. One of the most important advances in metabolic surgery is its impact on type 2 diabetes. In this review, the effect of metabolic surgeries, and their physiological and molecular effects have been investigated on weight loss, improvement of diabetes, and metabolic disorders. Materials and methods: Metabolic surgeries have been introduced as an effective treatment modality for type 2 diabetes. This review discusses various types of metabolic surgeries along with their benefits and drawbacks. It also explores the different physiological and molecular mechanisms that contribute to the improvement or remission of diabetes. Results: In general, anatomical, physiological, and molecular changes in the gastrointestinal tract, independent of weight loss, can effectively improve blood glucose levels and regulate insulin secretion over a long period. The most important effects of metabolic surgery include enhanced insulin sensitivity, improved functionality and enhanced quantity of β cells in the pancreas, increased insulin release by affecting incretin hormones, alterations in the configuration and circulation of bile acids and intestinal microbiota, and improvement in intestinal glucose metabolism. Conclusion: Considering the significant effects of metabolic surgery on improving type 2 diabetes independent of weight loss, it would be valuable to explore the different mechanisms that contribute to glucose reduction after surgery.

In recent years, the incidence of infections caused by pathogenic fungi has increased globally, especially in immunocompromised patients, transplant patients, or patients undergoing chemotherapy in intensive care units. Due to the morbidity and rapid spread of infection to other organs, accurate, rapid diagnosis and treatment of fungal infections is essential. Molecular methods such as polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) have significant superiority in sensitivity and specificity compared to conventional methods. The aim of this study is to point out the limitations of common diagnostic methods and factors affecting the sensitivity and specificity of PCR-RFLP molecular diagnostic test. This article is a review study for which subject-related academic papers (before 2023) were collected and studied by searching the keywords of pathogenic fungi, and RFLP molecular diagnostic methods,in Persian databases as well as Latin electronic databases including Scopus, Web of Science, and PubMed. Reviewing numerous articles showed that PCR-RFLP is a rapid, practical, and reliable method, which can be used in laboratories to determine the genotype of specific variants of fungal species isolated from clinical samples. However, there are several limitations for PCR-RFLP method demanding for more attention. The main limitations are the need for specific restriction enzymes and the difficulty of accurately determining single nucleotide polymorphisms (SNPs) in a specific diagnostic locus.

Correction to: Congenital Anomalies of Kidney and Urinary Tract in a Dissected Cadaver: Case Report

Correction to: Effect of Mindfulness-Based Stress Management Therapy on Emotion Regulation, Anxiety, Depression, and Food Addiction in Obese People: A Randomized Clinical Trial