Journal of Mazandaran University of Medical Sciences
Year:2023 | Volume:33 | Issue:230|Papers Count:15

Background and purpose: Stress is a stimulus that leads to a physical or psychological reaction. Stress affects memory and cognition. Common drugs for treating stress and memory disorders have limited effects and many side effects, so the search for new effective compounds with natural origin and fewer side effects is of interest. Various studies have shown that Terminalia chebula) T. chebula (and crocin are effective in improving memory. Several proteins, including synapsin-1, synaptophysin, and PSD95, are involved in the transmission of nerve messages in synapses involved in memory. In this study, the effect of the hydroalcoholic extract of T. chebula and crocin in improving memory and stress and the expression of synaptophysin, PSD 95, and synapsin-1 genes in the hippocampal tissue of male rats of the immobility stress model has been evaluated. Materials and methods: 25 adult male Wistar rats were randomly divided into five groups, including a control group, a stress group, treated with hydroalcoholic extract of T. chebula group, treated with crocin group, simultaneously treated with hydroalcoholic extract of T. chebula, and crocin group. All groups except the control group were subjected to immobility stress for 14 days. Crocin was injected intraperitoneally (30 mg/kg) and hydroalcoholic extract of T. chebula was given as intragastric gavage (50 mg/kg). After fourteen days, the shuttle box test was performed to check the memory, then the animals were anesthetized and their hippocampal tissue was isolated, and the expression changes of synapsin-1, synaptophysin, and PSD 95 genes in the tissue were analyzed by Real-time PCR method. Results: Immobility stress caused disruption in two memory indicators, i. e. increased the duration of staying in the dark chamber (P˂0. 01) and decreased the latency time to enter the dark chamber compared to the control group (P˂0. 0001). Treatment with the alcoholic extract of T. chebula did not affect the duration of staying in the dark chamber (P>0. 05), but crocin decreased it compared to the stress group (P˂0. 05). The hydroalcoholic extract of T. chebula and crocin increased the latency time to enter the dark chamber compared to the stress group (P˂0. 01 and P˂0. 001, respectively). As a result, both of them affected memory improvement parameters. The combination of the hydroalcoholic extract of T. chebula and crocin decreased the duration of staying in the dark chamber (P˂0. 05) and increased the latency time to enter the dark chamber compared to the stress group (P˂0. 001). Also, Immobility stress decreased the expression of synaptophysin, synapsin-1, and PSD95 genes in the hippocampus tissue compared to the control group (P˂0. 001 for all genes). The expression of synaptophysin, synapsin-1, and PSD95 genes in the hippocampus tissue of groups treated with hydroalcoholic extract of T. chebula (P˂0. 01, P˂0. 01 and P˂0. 001, respectively), crocin (P˂0. 001, P˂0. 01 and P˂0. 001, respectively), and their combination (P˂0. 001, P˂0. 001 and P˂0. 01, respectively), increased compared to the stress group. Conclusion: treatment with crocin and hydroalcoholic extract of T. chebula separately or their combination was effective in improving memory and reducing stress by increasing the expression of synapsin 1, synaptophysin, and PSD95 genes.

Background and purpose: The use of antibiotics is one of the most important ways to deal with bacterial infections. However, the improper of antibiotics and the emergence of drug resistance have compromised the effectiveness of antibiotics. Staphylococcus aureus causes a wide range of clinical diseases, and infections caused by this pathogen are increasing rapidly in the community and hospitals. Today, the treatment of this pathogen has become a challenging issue due to the emergence of multi-drug resistant strains such as MRSA (Methicillin-resistant Staphylococcus aureus). Since the antibiotic resistance of pathogens has become a global public health problem, the introduction of novel drug candidates against pathogens has become a necessity. Recently, there have been more reports on the use of OMVs as active antibacterial agents or carriers of antibiotics, which indicates the potential of OMVs in antibacterial therapy. The study aims to evaluate the effect of outer membrane vesicles of E. coli Nissle 1917 on the growth ability of Staphylococcus aureus strains. Materials and methods: The present study was conducted on 50 samples of Staphylococcus aureus isolated from wounds, urine, and blood. In this study, to emphasize the beneficial effect of OMVs derived from the probiotics (EcN) as a postbiotic agent, the outer membrane vesicles were extracted using the ultracentrifugation method. After confirming the presence of protein content by the SDS-PAGE method, we confirmed the structure and maintained the integrity of the vesicles during the extraction process using a FE-SEM electron microscope. Finally, to evaluate the effect of these structures on the viability of Staphylococcus aureus, we used the MTT method. Results: In the analysis of the protein pattern by SDS-PAGE, protein bands in the range of 15 to 100 kDa were observed. Also, the structure and integrity of outer membrane vesicles in the range of 40 to 100 nm were confirmed by an electron microscope. Finally, we saw a significant decrease in growth inhibition of all Staphylococcus aureus strains in the presence of outer membrane vesicles caused by EcN. Conclusion: Considering the non-proliferative nature of OMV structures and their effects similar to probiotics, as well as, results obtained due to the significant reduction of growth inhibition of Staphylococcus aureus strains in the presence of outer membrane vesicles caused by EcN, it seems that these compounds can be a powerful tool for developing therapeutic approaches for human health and a better lifestyle.

Background and purpose: To treat kidney cancer, methods such as surgery, chemotherapy, immunotherapy, etc. are used, which cause many side effects, thus, we try to use methods that have fewer side effects, such as the use of plant compounds. Considering the importance of changes in the function of genes, especially vital genes during cancer, in this study, the genes involved in the cell cycle, including P53 and CDK2, were investigated. The purpose of this study was to investigate the antioxidant properties and cytotoxic effect of Scutellaria pinnatifida extract on the survival and expression level of genes involved in the cell cycle (P53 and CDK2) in kidney cancer. Materials and methods: In this experimental-laboratory study, Scutellaria pinnatifida extract was prepared by soaking method and the presence of phytochemical compounds in the extract was investigated qualitatively. Kidney cancer ACHN cells were cultured. The cytotoxic effect of an extract with concentrations of 1000, 500, 250, 125, 100, and 62. 5 µg/ml was measured by MTT assay (3-(4, 5-Dimethylthiazol-2-yl)-2, 5-Diphenyltetrazolium Bromide) which is a color method. The assay is to check the proliferation and survival of cells, it was measured at 24, 48 and 72 hours. Then, RNA extraction was performed from the treated cells with concentrations of 500 and 250 µg/ml, and the concentration and quantity of the extracted RNAs were measured using nano drops. Then cDNA was made from the extracted RNAs and the expression levels of P53 and CDK2 genes were analyzed using Real-Time PCR. DPPH (Diphenyl picrylhydrazyl) test was used to evaluate the antioxidant properties of the extract which is based on the measurement of antioxidant inhibition capacity. Results: According to the results obtained from the phytochemical tests, the spike plate plant extract contains flavonoids, triterpenoids, asteroids, sterols, and glycosides, but it does not contain alkaloids, tannins, and saponins. MTT assay showed that Scutellaria pinnatifida extract has a lethal effect on ACHN cells and this effect is dose and time-dependent. By decreasing the concentration of spike plate plant extract, the survival rate of cells increased significantly, and by increasing the duration of treatment from 24 to 72 hours, the survival rate in kidney cancer cells decreased significantly. Real-Time PCR also showed increased expression of the P53 gene and decreased expression of the CDK2 gene in ACHN cells treated with Scutellaria pinnatifida extract. Changes in expression are also dependent on dose and time. The antioxidant test confirmed the antioxidant properties of the extract and it showed that the antioxidant properties of this plant depend on the concentration. Value in this study is less than 0. 05 (P<0. 05). Conclusion: The findings show that Scutellaria pinnatifida extract can have an anti-cancer effect and destroy ACHN cancer cells. Changes in P53 and CDK2 gene expression in ACHN cells indicate that Scutellaria pinnatifida extract probably disturbs the cell cycle in kidney cancer cells and thereby reduces the survival of these cells. Therefore, it can be considered a compound with anti-cancer properties

Background and purpose: Recent advances in the improvement of mechanical, physical, and esthetic properties of dental composites have greatly contributed to their increasing use. However, mouthwashes with an alcohol base may adversely affect some properties of composite resins, and cause problems such as discoloration, and composite wear. Considering the increasing use of composite resins, growing demand for esthetics, and increased consumption of mouthwashes, it is imperative to assess the effect of mouthwashes on the physical properties of composite resins, such as their surface roughness. This study aimed to examine the effect of an alcohol-containing mouthwash on the surface roughness of microhybrid and nanohybrid composite resins. Materials and methods: This experimental study was conducted with the code of ethics IR. IAU. DENTAL. REC. 1399. 049 on 3/24/2019 at the Faculty of Dentistry, Islamic Azad University of Medical Sciences, Tehran. Sixty IPS Empress Direct (Ivoclar) nanohybrid and Vit-l-essence (Ultradent) microhybrid composite resin specimens were fabricated were fabricated with 5 mm diameter and 2 mm thickness. The specimens were immersed in distilled water at 37°C for 24 hours and were then polished with aluminum oxide abrasive discs. The specimens were then immersed in 20 mL of distilled water for 24 hours. After 24 hours, the baseline surface roughness of specimens was measured by atomic force microscopy (AFM). IPS Empress Direct and Vit-l-essence composite specimens were randomly divided into two subgroups (n=15) for immersion in 20 mL of Listerine alcohol-containing mouthwash and Listerine non-alcoholic mouthwash and incubated at 37°C for 24 hours. This protocol simulated the daily use of mouthwash for 2 minutes for a one-year duration. Their secondary surface roughness was measured by AFM. The change in surface roughness of specimens was analyzed and compared by two-way ANOVA and t-test. Results: The measurement of the initial surface roughness showed higher values in the microhybrid composite than in the nanohybrid composite. The greatest change in surface roughness occurred in the Vit-I-essence micro-hybrid composite following immersion in alcoholic mouthwash,while the smallest change occurred in the IPS Empress nanohybrid composite immersed in non-alcoholic mouthwash. Two-way ANOVA showed that the roughness difference was significant for groups immersed in alcoholic mouthwash, indicating different behavior of the two composite types following immersion in alcoholic mouthwash. The results showed that immersion of composite specimens in mouthwashes increased their surface roughness. However, the change in surface roughness of IPS Empress and Vit-I-essence composite specimens was significantly different following immersion in alcoholic mouthwash, and Vit-I-essence experienced a significantly greater change in surface roughness than IPS Empress. Conclusion: The surface roughness of both composite types increased following immersion in mouthwashes irrespective of the presence/absence of alcohol. The surface roughness of both composite types after immersion was<0. 2 µm, and therefore, clinically acceptable. Listerine alcoholic mouthwash increased the surface roughness of both composite types significantly more than Listerine non-alcoholic mouthwash. The increase in surface roughness of microhybrid composite was greater than that of nanohybrid composite following immersion in alcoholic mouthwash.

Background and purpose: after heart diseases and accidents, cancer is considered the third cause of death in Iran (1), and is a major health problem not only in Iran but also in many developed and developing countries. (2). Breast cancer is a disease in which breast cells grow out of control. This disease has different types based on the type of breast cells that become cancerous. Breast cancer accounts for about one-third of all types of cancer in the female population and is the main cause of cancer-related deaths in women worldwide (3). Estrogen receptor-α is one of the isoforms of estrogen receptor encoded by the ESR1 gene. ESR-α is a nuclear receptor that acts as a ligand-dependent transcription factor (4). After binding of estrogen, ESR-α binds to the estrogen response regions in the promoter of the target genes and causes changes in the expression of the target genes (5). The present study investigates the expression level of the estrogen receptor gene (ESR1) and long non-coding RNAs (lncRNAs) related to It investigates the allele frequency and genotype of single nucleotide polymorphism (SNP) rs2234693 in ESR1 gene in patients with breast cancer. Materials and methods: In this case-control study, the expression of ESR1 and related coding and non-coding RNAs were investigated by microarray (17 control samples and 104 patient samples), TCGA RNAseq (on 113 normal samples, 1102 primary tumors and seven Metastatic tumor samples) and data analysis was done by R Studio and limma, and ENCORI and GEPIA2 databases. Evaluation of microRNA interaction was done by miRWalk and lncRNA interaction finding was done by lncBase 3. Protein-protein interaction was analyzed by STRING and survival and correlation analysis by GEPIA2 and ENCORI. Pathway enrichment and gene ontology (GO) analyses were performed by KEGG and Enrichr and SNP analysis was performed by RFLP test. Results: ESR1 gene expression was increased in breast cancer and miR-15a-3p gene had a significant interaction with ESR1 and lncRNA OIP5-AS1. OIP5-AS1 and ESR1 had significant positive expression in patient samples. The frequency of TC, TT, and CC genotypes in healthy people was 65%, 15%, and 20%, respectively, and in the patient group it was 38. 5%, 38. 5% and 23%. There was a significant difference in the prevalence of ESR1 gene genotypes between patients and controls. Conclusion: ESR1 polymorphism may be associated with an increased risk of breast cancer and rs2234693 T>C SNP can be considered a strong marker for breast cancer screening. OIP5-AS1 may regulate breast cancer progression by altering ESR1 expression regulation.

Background and purpose: Hemodialysis patients often face various psychological challenges that can significantly affect their overall health. Alexithymia is a construct that refers to the inability to distinguish between emotions and bodily reactions, difficulty describing emotions to others, and a cognitive style that is driven by reality and concrete situations. Various studies have shown that alexithymia is significantly and positively correlated with many psychiatric disorders. Moreover, as a factor, it hurts mental health (especially anxiety) and the quality of life of hemodialysis patients. Therefore, this research aimed to determine the mediating role of alexithymia in the relationship between social support and death anxiety in hemodialysis patients. Materials and methods: This cross-sectional and analytical study was conducted on 235 patients at Sari Shahrvand dialysis center, Iran 2023. Patients were included in the study by convenient sampling method. Data collection was done using demographic information questionnaires, Templer's Death Anxiety Scale (DAS-15), Zimmet's Multidimensional Scale of Perceived Social Support (MSPSS), and Toronto Alexithymia Scale (TAS-20). Demographic information included gender, place of residence, level of education, duration of hemodialysis treatment, number of visits per week, history of underlying diseases, and history of hemodialysis. Templer's death anxiety scale includes 15 questions in the form of a 5-point Likert scale regarding thoughts of death, fear of death, talking about death, fear, and thinking about incurable diseases. Zimmet's multidimensional scale of perceived social support is a 12-question instrument in the form of a 7-point Likert scale, which was used to evaluate perceived social support from three subscales of friends, family, and significant others. The Toronto Alexithymia Scale was a 20-question questionnaire with a five-point Likert scale, with three subscales: difficulty in recognizing emotions, difficulty in describing emotions, and objective thinking (Externally oriented), which was used to evaluate alexithymia. Finally, the data was analyzed by descriptive statistics and structural equation modeling with the bootstrap method, utilizing SPSS 26 and AMOS 22. Results: The study revealed that most participants were male, comprising 58. 3% of the statistical population. The average scores for death anxiety, perceived social support, and alexithymia were 38. 97±10. 31, 4. 88±1. 26, and 55. 72±9. 76, respectively. The results suggest that there is no statistically significant relationship between social support scores and death anxiety (B=-0. 13 (-0. 30, 0. 04), P=0. 153), nor between social support and alexithymia (B=-0. 12 (-0. 28, 0. 09), P=0. 256). However, there is a significant and direct relationship between alexithymia and death anxiety (B=0. 66 (0. 46, 0. 82), P=0. 016). Conclusion: Considering the significant and direct relationship between alexithymia and death anxiety, it is recommended that managers and healthcare planners regularly evaluate the presence of death anxiety and alexithymia among individuals and formulate targeted interventions to alleviate these conditions.

Background and purpose: Mental health problems in adolescence have a high prevalence and students are also affected by these problems as an active segment of society. In this context, mental health literacy and seeking professional psychological help are important components in the prevention, diagnosis, and timely treatment of mental disorders. the present study aims to examine the relationship between mental health literacy and attitude towards seeking professional psychological help in high school students of Amol City during the academic year 2022-2023. Materials and methods: This is a descriptive-analytical cross-sectional study conducted on high school students of Amol City during the academic year 2022-2023. With multi-stage random sampling, 416 students participated in the research, and considering the inclusion and exclusion criteria, 357 were analyzed. Data were collected using the demographic and educational form, mental health literacy scale (MHLS), and short form of attitude towards seeking professional psychological help scale (ATSPPH-S). Data analysis was performed using SPSS V22, employing descriptive statistics tests, univariate and multiple generalized linear regression models. Results: In this study, the mean age of the participants was 16. 62±0. 645 years and 52. 4% of them were males. Also, most of them were in the 11th grade and studying technical and professional fields. The results of the study showed that the average mental health literacy and attitude towards seeking professional psychological help in students were 78. 32±9. 17 and 15. 70±4. 31 respectively which were almost in the middle range. The ability to identify mental disorders had the highest average (23. 34) and the awareness of risk factors had the lowest average (5. 12) among the components of mental health literacy. The result of univariate generalized linear regression indicated that there was a significant relationship between attitude towards seeking professional psychological help and students' mental health literacy (P<0. 05). Moreover, multiple generalized linear regression’s results showed that attitude towards seeking professional psychological help, gender and mothers' education had a significant relationship with students' mental health literacy(P<0. 05). Other demographic and educational variables had no significant relationship with mental health literacy(P<0. 05). Conclusion: Considering the direct and meaningful relationship between mental health literacy and attitude towards seeking professional psychological help in students, it is suggested that managers and educational and health officials make decisions to improve the mental health literacy of students. This can increase their willingness to seek psychological support when necessary. It is also important to create suitable conditions for training and improving the mental health literacy of the parents of students so that they can play an effective role in improving the mental health of themselves and their children.

Background and purpose: Driving is a crucial ability that can impact the quality of life for elderly individuals. Older adults may rely more on driving compared to other age demographics. As individuals age, there are significant changes in physical, cognitive, intellectual, and emotional abilities that are crucial for driving, a skill essential for accessing healthcare, therapy services, work, and social activities, as well as maintaining independence and autonomy in the elderly. Mobility and physical exertion are crucial aspects of health for older individuals, and driving significantly contributes to their ability to move within society. The increase in the elderly population has led to a rise in the number of older drivers. Proficiency in self-efficacy in driving is a crucial ability in this profession that acknowledges the significant aspects of this issue. This study aimed to investigate the correlation between weariness, self-efficacy, and driving behavior among older drivers in an urban setting. Materials and methods: This study was a progressive and descriptive-analysis study conducted among older drivers aged 60 and older who were members of the taxi association. Three hundred and ten eligible participants were chosen using the convenience sampling approach. The data was collected using the demographic data form, the multidimensional fatigue inventory, and Adele's self-efficacy scale. The data was analyzed using descriptive statistics, multiple linear regression, and Pearson correlation tests. Results: The participants had an average age of 28. 3 years with a standard deviation of 9. 6 years, and their ages ranged from 60 to 75 years. 42% of the participants had university degrees. They mostly had 30 to 50 years of driving experience. The average self-efficiency in driving among older drivers was 101. 87±15. 74. The Pearson correlation test indicated a significant and inverse relationship between age factors, the history of the driving license, and the self-efficacy score. In other words, as age and years of driving experience increase, the likelihood of self-efficacy driving reduces substantially. The correlation between the fatigue questionnaire scores and self-driving efficiency was significant(P<0. 001). There was an inverse relationship between fatigue and self-efficacy in driving. Higher fatigue levels in older adults led to a decrease in self-activity rates. Multiple linear regression analyses revealed strong associations between educational characteristics, the economic-social status of chronic illness, self-efficiency scores, and fatigue rates. The model indicates that the fatigue score decreases by 0. 18 for every one-unit rise in the self-efficiency score. The regression analysis showed that monthly income, vehicle type, and fatigue score were significantly related to driving self-efficacy score(R2=39. 5). Conclusion: Researchers recommend implementing a driving rehabilitation program and interventions that provide psychological support in reducing fatigue for older adult drivers based on these findings. The results of the study could assist policymakers in the field of gerontology in planning rehabilitation programs to enhance self-efficacy in driving in older individuals. These programs would consider the factors that contribute to decreased driving efficiency in older drivers and would be implemented in collaboration with welfare organizations and municipalities.

Background and purpose: Prostate cancer is the most common male urogenital malignancy in many regions of the world, which has been increasing in recent years all over the world, including Asian countries, as well as in Iran. The relative risk of prostate cancer for those who have a family history of this disease in close relatives is almost 2 to 3 times, and the incidence rate increases with the increase in the number of affected relatives. Although family history of prostate cancer is a proven risk factor for this disease, few studies have investigated the relationship between the presence of family history of prostate cancer and the degree of prostate cancer risk. The purpose of this study is to investigate the relationship between the existence of a family history of prostate cancer and the degree of prostate cancer risk at the time of diagnosis. Materials and methods: This case-control study was conducted on 322 patients available prostate cancer patients referred to medical centers affiliated with Babol University of Medical Sciences. Patients were divided into two groups: case (family history of prostate cancer) and control (no family history of prostate cancer). Information about family history, Gleason score, PSA, and clinical stage was extracted from all patients. It was extracted through the file and phone call. A positive family history of prostate cancer is defined as follows: patients who have at least two of their first-degree relatives with prostate cancer at any age. Also, patients who have one first-degree relative and at least two second-degree relatives at any age with prostate cancer. In hereditary prostate cancer, at least 3 first-degree relatives have prostate cancer, or prostate cancer occurs in three consecutive generations of the same family (paternal or maternal). At least two first-or second-degree relatives had early onset prostate cancer under the age of 55. The relationship between the existence of a family history of prostate cancer first-degree relatives include: father, brother, and child, and second-degree relatives include: grandfather, uncle and cousin. the degree of prostate cancer in three groups (Low risk with PSA<10, Gleason score<7, intermediate risk with PSA between 10 and 20 or Gleason score 7, and high risk with PSA>20 or Gleason score>7) at the time of diagnosis was investigated. Results: The average age of patients when diagnosed with prostate cancer was 67. 23±8. 97 years, who were in the age range of 43-93 years. 23. 3% of the studied patients had a family history of prostate cancer and 1. 9% had a hereditary family history of prostate cancer. With the increasing age of diagnosis, the degree of risk of prostate cancer increased, which is statistically significant. Thus, 63. 9% of patients who were diagnosed with prostate cancer at the age of 71 years had high-risk prostate cancer, which shows that the risk level of prostate cancer should increase as the age of prostate cancer diagnosis increases (P=0. 001). Between the ages of 61 and 70 years, 62 people (44. 9%) were at a high risk level, while at the age of 60 years, 33 people were at a high risk level (P<0. 001). Also, there was a statistically significant relationship between the positive family history of prostate cancer and the degree of risk (75 positive cases (23. 3%) versus 247 negative cases (76. 7%) (P<0. 05). Conclusion: The findings of the study showed that there is a positive relationship between the family history of prostate cancer and the degree of prostate cancer risk, which indicates the importance of prostate cancer screening with PSA and digital rectal examination from the appropriate age in these patients.

Background and purpose: Access to primary healthcare services, considering equity and equality in the health system, is a right of the global community. To provide primary health services, the rural family physician program was implemented at the beginning of 2005 to achieve universal health coverage in rural areas and small cities (with a population of less than 20, 000). The specific goals of this program included the implementation of the referral system, increasing the responsiveness of the health market, increasing people’s access to health services, reducing unnecessary costs in the health market, and increasing service coverage. After approximately 7 years of implementation of this program, the urban family physician program started in Mazandaran and Fars province as a pilot project. The urban family physician program started in the Mazandaran province in 2012 as the first level of providing health services. In line with the better implementation of this program and considering the wide range of expected programs and activities, it is essential to entrust the appropriate activities with the time of the service providers. This study was conducted to assess the expected duration of activities assigned to the family physician. Materials and methods: This cross-sectional study was conducted on 15 urban family physician centers (6 government and 9 private centers) in Golugah, Behshahr, Neka, Ghaemshahr, Noor, and Chalus cities of Mazandaran province. Out of 15 cities with more than 20, 000 people participating in this program in Mazandaran province, the six cities mentioned above were randomly selected, and 15 urban family doctors were randomly selected from the existing list. Finally, the target groups were included in the study for convenience sampling. To collect the data, checklists compiled based on care packages corresponding to 8 groups of service recipients (elderly (11 services), middle-aged (7 services), youth (13 services), teenagers (24 services), under 5 years old (6 services), mana (15 services), mothers (3 services), and non-target visit) were used. For each service recipient group, at least three individuals were examined. Central and dispersion indices were used to describe the data. Results: The results of measuring the time of providing service to 297 people (including 90 under 5 years old, 30 people receiving Mana services, 30 people from each of the groups of mothers, teenagers, young people, middle-aged, elderly, and 27 people from non-target visit) showed that the median and mean expected time for providing daily service by an urban family physician to the covered population is 2 h and 52 min and 3 h and 23 min, respectively. The estimated time was different in the groups receiving the service, the highest time of which was related to the visit of the non-target service group with median and mean of 84. 17 and 87. 20 min, respectively, and the lowest time was related to Mana services with a median and mean of 3. 40 and 4. 34 min, respectively. Conclusion: Urban family physicians have enough time to provide daily services, and therefore it seems that the health system has not assigned them more than their daily time capacity.

Background and purpose: Preventing ventilator-associated pneumonia (VAP) as one of the most common and also the most fatal complications caused by intubation and mechanical ventilation in intensive care units (ICU) has always been emphasized in countless studies. Chlorhexidine mouthwash is commonly used as a gold standard in the control of dental plaques and prevention of VAP. Given the increasing prevalence of gram-negative infections due to resistance to commonly used antibiotics and the associated complications, this study aimed to investigate and compare the impact of tea tree oil/aloe vera herbal mouthwash, known for its antibacterial and anti-inflammatory properties, on the occurrence of ventilator-associated pneumonia. Materials and methods: This study is a double-blind randomized clinical trial. 62 intubated patients, aged from 16 to 65 and hospitalized in the intensive care units of Hazrat Waliasr Hospital in Arak City in 2023, were assigned using a simple randomization method in two interventions (tea tree oil/aloe vera mouthwash) and control groups (chlorhexidine mouthwash). Mouthwash bottles were covered before distribution. None of the patients, colleagues (nurses), and the specialist determining the final result of the study were aware of the allocation of patients in the intervention or control group. Oral care in both groups was performed by washing hands, wearing gloves, evaluating the mouth condition, adjusting the pressure of the endotracheal tube cuff (20-30 Cm. H2O), brushing with a soft toothbrush, mouthwash twice daily and open suctioning of oral and subglottic secretions. Lastly, at intervals of 3 days (to assess the incidence of early VAP) and 7 days (to assess the incidence of late VAP) after the intervention, the modified clinical pulmonary infection score (MCPIS) was calculated and a score greater than or equal to 6 was considered as a diagnosis of pneumonia. This tool has been utilized in similar studies and its validity and reliability have been confirmed. Eventually, the data was statistically analyzed using the chi-square test, independent t-test, and repeated measures test to investigate the effect of the intervention over time with SPSS version 20 software. Results: According to the results, 64. 5% of the participants were male and 35. 5% of them were female. There was no statistically significant difference between the two groups in terms of average age, gender, reason for admission, history of underlying diseases, invasive interventions, average number of drugs and antibiotics, type and amount of nutrition, and duration of mechanical ventilation. The incidence of early-onset pneumonia was 9. 7% in the intervention group and 12. 9% in the control group. Although the incidence was lower in the intervention group, there was no statistically significant difference between the two groups (P-value=0. 99). The incidence of late-onset pneumonia in the intervention group was 12. 9% and 16. 1% in the control group. Despite of lower incidence of late-onset pneumonia in the intervention group, there was no statistically significant difference (P-value=1. 00). Moreover, according to the results of Bonferroni's paired comparisons test, the difference in the average MCPIS score between 3 days and 7 days later in the intervention group was not significant and did not increase significantly (P-value=0. 06), which means that in this group, the effect of the intervention can be seen at this time. Conclusion: Oral care using tea tree oil/aloe vera mouthwash or 0. 2% chlorhexidine has no preference or significant advantage over each other, and both can be effective in reducing ventilator-associated pneumonia. Considering the lower incidence of early and late pneumonia in the intervention group, it is recommended to conduct studies with a larger sample size and also use accurate oral assessment tools to confirm the removal of dental plaque (plaque score) in this population of patients.

Background and purpose: Hypoxia, a decrease in available oxygen reaching the tissues, may cause a variety of physiological abnormalities. It is linked to the pathology of stroke, cardiovascular disease, and acute mountain sickness. Hypoxia occurs especially in heart diseases, ischemia, and heart attack, and finally causing death. Hypoxia causes oxidative stress involving the production of reactive oxygen species (ROS). Compounds with antioxidant activity can scavenge ROS and can exhibit anti-hypoxic properties. Pomegranate (Punica granatum) is a well-known fruit with very good anti-ischemic and antioxidant activities. Little is known about the protective effects of pomegranate against hypoxia-induced lethality. Several medicinal plants have accepted anti-hypoxic activities. In the present study, the protective effect of this fruit against hypoxia-induced lethality in mice was determined by three different experimental models. Materials and methods: Protective effects of methanolic extract of Pomegranate's seed and peel against hypoxia-induced lethality in mice were evaluated by three experimental models of hypoxia, i. e. asphyctic, haemic, and circulatory models. The latencies for death for mice were recorded. All the experimental procedures were conducted by the NIH guidelines of the Laboratory Animal Care and Use. The Institutional Animal Ethical Committee of Mazandaran University of Medical Sciences also approved the experimental protocol. In the asphyctic hypoxic model, phenytoin (50 mg/kg, i. p. ) and in the next two tests, propranolol (20 and 30 mg/kg, i. p. ) were used as the positive control. In all tests, Normal saline (0. 5 ml, i. p. ) was used as the negative control. One-way analysis of variance (ANOVA) was performed followed by the Newman-Keuls multiple comparisons test was used to determine the differences in means. All p values less than 5% were considered as significant. Results: Extracts showed good anti-hypoxic activities in some tested models in mice. In the hemic model, Peel extract at 250 mg/kg significantly prolonged mice survival time for about 4. 8 minutes (P<0. 001). At this dose, it showed the same activity of propranolol 20 mg/kg which was used as positive control. In the circulatory antihypoxic model, peel extract at 250 mg/kg, significantly increased the survival time by about 5. 4 minutes (P<0. 0001). At this dose, the extract showed the same activity as propranolol 30 mg/kg (P>0. 05). In the asphyctic anti hypoxic model, seed extract at 250 mg/kg prolonged the survival time for 2. 4 minutes in the control group. But this increase was not statistically significant (P>0. 05). Peel extract at 62. 5 mg/kg prolonged the survival time for 4. 2 minutes in the control group, but this increase was also not statistically significant (P>0. 05). Peel extract showed good activity in an asphyctic model where at 125 mg/kg. It increased the survival time of mice about 2 times (P<0. 0001). At this dose, extract showed higher activity than phenytoin 50 mg/kg. The survival time for the group that received phenytoin was 29. 60 ± 2. 51 minutes which was statistically significant than that of the control group (P<0. 001). Conclusion: Extracts showed very good protective effects against hypoxia in some tested models. In particular, the effects in the asphyctic model of hypoxia were high. Peel extract was stronger than seed extract. Phenolic compounds may be responsible for the anti-hypoxic activities of these extracts

Background and purpose: The quality of sexual life is one of the important branches of the quality of life and it is a means to examine the relationship between sexual problems and the quality of life. The meaning of life is also one of the indicators affecting the quality of life. Among the country's population, students are exposed to questions about the meaning of life due to being in a period of youth transformation. The purpose of the present study was to investigate the relationship between the meaning in life and the quality of sexual life of married students of Mazandaran University of Medical Sciences and their spouses in 2023. Materials and methods: In this cross-sectional descriptive-analytical study, after being approved by the ethics committee with code IR. MAZUMS. REC. 1401. 17162, 185 couples of married students of Mazandaran University of Medical Sciences and their spouses were included in the study in May and June 2023 with two stages stratified sampling method with proportional allocation. First, married students of each faculty was determined then participants were included with convenience method. Inclusion criteria were willingness to participate, being Iranian, being married, having a surviving spouse, and Monogamy, while exclusion criteria was unwillingness of the spouse to complete the questionnaire. They completed questionnaires on the Quality of sexual life, the Meaning in life, DASS-21, socio-economic status, and demographic-medical-psychological information form made by the researcher. SPSS 25 software and Pearson correlation coefficient, independent two-sample t-test, one-way ANOVA, and mixed model linear regression with Backward model were used. The drop rate was 20% and the significance level was P<0. 05. Results: The response rate in this study was 87. 2%. The average age of men is 31. 88±7. 87 and women is 28. 81±8. 34. The average score of the quality of sexual life of men and women in the study was 59. 25±8. 54 and 93. 60±15. 05. According to the paired t-test, the score of the quality of sexual life of men is 6. 15±2. 53 units higher and significant (P<0. 001). According to mixed linear regression with the Backward model, there is a significant relationship between the quality of sexual life of couples with a marriage duration (6-10 years (r=-14. 69) and 11-15 years (r=-19. 08), place of living with family in the city (r=18. 76) and village (r=27. 43)), lack of privacy (r=-28. 29), owning a residential house (r=7. 64), not suffering from physical illness (r=15. 09) and psychiatric illness (r=15. 04), infertility (r=-10. 00), lack of education on sexual issues (r=-6. 76), socioeconomic status in the form of self-assessment of housing prices in the intermediate range (r=8. 85) and self-assessment of financial ability to buy housing is very low (r=-14. 52), depression (r=-1. 93) and meaning of life (r=0. 11)(p<0. 05). Conclusion: The meaning in life in the presence of other demographic, medical, psychological, and socioeconomic factors had a continuous and significant relationship with the quality of sexual life and it is necessary to pay attention to these factors in planning related to students. further studies can be conducted to search for factors that improve the meaning of life and, accordingly, the quality of sexual life of students and their spouses.

Background and purpose: Congenital heart defects (CHD) are conditions that arise from birth and affect the structure and function of the baby's heart. Children with CHD have a higher number of decayed, missing, or filled teeth due to caries (DMFT) and have poorer oral health than healthy children. Most researchers believe that knowledge and attitude about oral hygiene are effective factors in oral health-related behaviors. In addition, psychological factors increase a person's willingness to act to observe hygiene. Therefore, the current study aims to compare the deft index as well as the oral health-related quality of life in children aged 3-6 years with congenital heart disease (CHD) and healthy children. Materials and methods: In this case-control study, 28 children aged 3 to 6 years with CHD and 28 healthy children referred to Toubi Clinic were selected by census sampling method. After obtaining informed consent from the parents, the Childhood Oral Health Impact Index (ECOHIS) was provided to them. This questionnaire contained 13 questions and was classified into two areas: child impact scale (CIS) and family impact scale (FIS). The CIS section had 4 components: disease symptoms (1 question), child performance (4 questions), psychological (2 questions), child's self-confidence and social interactions (2 questions). The FIS section also included areas of parents' concerns (2 questions) and family function (2 questions). In general, the total raw scores of this index ranged from 0-52, which was 0-36 in the CIS section and 0-16 in the FIS section. The higher the final number of the ECOHIS index the more oral health problems and the more inappropriate OHRQOL. Statistical analysis was performed using SPSS V. 25 software and the Mann-Whitney test. Results: A total of 56 people participated in this study, of which 24 (42. 9%) were girls. The average age of the participants was 4. 64 years. Based on the findings of this study, the average dmft index in CHD group children was 6. 42 ± 3. 27, and in healthy children, this number was 5. 92±2. 9. The observed differences between the two groups were not statistically significant (P=0. 492). The mean score of the CIS section of the questionnaire was 2. 57±3. 96 in CHD children and 4. 64±5. 15 in healthy children (P=0. 082). In addition, the mean score of the FIS section was 2. 5±3. 06 in CHD children and 4. 4±4. 4 in healthy children, which was statistically significant in this study (P=0. 026). Conclusion: In this study, the difference in the dmft index between CHD and healthy children was not statistically significant, but this index was higher in the CHD group. CHD children showed better quality of life related to oral health than healthy children. The quality of life in CHD children can be better than that of healthy children and the higher dmft index in CHD children may be due to the higher number of f and m compared to healthy children, and for this reason, a child with congenital heart disease may experience less dental pain than a healthy child.

Background and purpose: Degenerative joint disease, especially osteoarthritis (OA), is a global disease characterized by the destruction of articular cartilage, and subchondral bone. It is estimated that about 250 million people currently suffer from cartilage defects. So far, no definite and standard treatment method for OA has been reported. Recently, cell-based therapeutic techniques have been considered one of the best therapeutic strategies for the long-term treatment of articular cartilage diseases. However, many challenges include the large scale of cells required, thus the cell-free approaches are novel tools for cartilage defect treatment. For instance, extracellular vesicles (EVs) secreted by various cells such as MSCs are in charge of the therapeutic effects of stem cells. Therefore, recently EVs have advanced as powerful cell-free transfer tools, due to their high physicochemical strength and biocompatibility. Materials and methods: This study is a review study that summarizes the preclinical and clinical studies that used EV-derived from different cell sources and investigates their effectiveness in treating cartilaginous tissue lesions. Current studies used small or large animal models with experimental critical size defects in knee articular cartilage to examine the effectiveness of EVs derived from MSCs. The EVs were isolated from cell sources such as adipose-derived MSCs, Bone marrow-derived MSCs, or transgenic cells. In addition, EV isolation techniques as a main challenge in studies using EVs to treat OA, specifically described in the current study. We also showed EVs isolated from each cell have unique features such as anti-inflammatory, differentiation, and therapeutic properties. We explain recent studies that use EVs as a drug carrier such as small molecules, and microRNA bioactive factors. In addition, the isolation techniques of EVs and their characterization are other challenges that we explain. Results: Recent studies have shown that EVs isolated from different sources inhibit the progression of OA. Also, the results of some studies indicate the ability of EVs to repair injured cartilage. Many studies showed that in critical size defects of cartilage, the use of EVs needs scaffolds. Several studies have investigated the challenges of EV release and the required EV dose based on the size of the lesion. EVs are rapidly emerging as novel therapeutic approaches for treating cartilage lesions and OA. Despite many advances in cell therapy and promising results reported in numerous disease models, the use of cells especially genetically modified cells has limitations in regenerative medicine. It is worth noting that the use of EVs derived from stem cells or transgenic cells has no harm to the human body. As a result, therapeutic EVs have been introduced as a new therapeutic approach that does not have the same potential risks as cells. Conclusion: Despite the positive results of EV in the treatment of cartilaginous lesions, it appears that the EV therapeutic barrier requires further testing in larger animal models before clinical trials. For instance, the regeneration of critical-size lesions requires the use of EVs incorporated by suitable scaffolds under dynamic conditions. Therefore, the fundamental questions to be considered are: How to use EVs as a nanoparticle instead of stem cells in combination with tissue engineering methods? What are the biological properties of EVs? What doses of EVs have the mechanistic potential for the treatment of different sizes of cartilage lesions and how EVs are stable in lesions? What is the role of EVs in the homeostasis and pathogenesis of junctions?