JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2016 | Volume:26 | Issue:138|Papers Count:36

Background and purpose: Menopause is a physiological process and diabetes is a metabolic disease that occurs more frequently in older women. The present study investigated the effects of diabetes on some biochemical parameters and histopathological changes in ovariectomized rats.Materials and methods: Thirty two adult female rats were divided into four groups of 8 and studied for 55 weeks. The animals were assigned into a control group, an ovariectomized group (55 weeks), a third group in which diabetes was induced in the last 5 weeks of the study in rats with intact ovary. The next group included ovariectomized rats (for 55 weeks) in which diabetes was induced in the last 5 weeks of the study. Pathological alterations of liver, kidney, pancreas, lung and some serum biochemical parameters were determined in each group at the end of the study.Results: Diabetic and diabetic ovariectomized rats showed increase in serum levels of blood glucose, AST, ALT, GGT, ALP, calcium, urea, TG and HDL compared with the control group (P<0.05). Increased serum levels of LDH, TG, cholesterol, HDL, LDL were seen in ovariectomized rats compared with the control group (P<0.05). Pathological examinations revealed changes in all groups except in the control group.Conclusion: Our findings suggest that long term reduction of estrogen in ovariectomized diabetic rats can reduce the serum levels of glucose, AST, ALT, GGT, urea, VLDL and triglycerides compared with non ovariectomized diabetic rats.

Background and purpose: Diabetes mellitus is a common metabolic disease, currently affecting more than 280 million people worldwide. Centaurea cyanus known as cornflower has antioxidant properties and is used in traditional medicine in lowering blood sugar. This study aimed at determining the biochemical and histopathological changes in serum and the kidneys of diabetic rats treated with hydroalcoholic extract of Centaurea cyanus.Materials and methods: In this study, 60 male Wistar rats were divided into five groups (n=12 per group). Diabetes was induced by alloxan. The diabetic rats were treated for 8 weeks with hydro alcoholic extract of C. cyanus at two concentrations (400 and 800 mg/kg). Finally, the animals were anesthetized and the serum levels of glucose, creatinine and urea and kidney tissue catalase level were measured. The kidney tissue slides were histopathologically examined.Results: Histopathological examination showed that similar to the control group, there were no significant changes in histolological features of the group receiving 800 mg/kg extract of the C. cyanus. In the group treated with 400 mg/kg of the extract there were mild tubular changes. Biochemical examination showed higher levels of creatinine in the group receiving the extract at 800 mg/kg. The level of urea in the group receiving the extract at 400 mg/kg, was significantly higher compared to that of the control group. (P<0.05).Conclusion: Consumption of Centaurea cyanus extract at 800 mg/kg could prevent kidney tissue injuries in diabetic rats, but further investigations are required before its use in treatment of patients with diabetes.

Background and purpose: Pre-surgery and anesthesia anxiety are normal reactions to mental pressure in which the main symptom is hypokalemia. Chlordiazepoxide is used as a neuroleptic agent. This study aimed at evaluating the effect of Chlordiazepoxide on hypokalemia caused by anesthesia anxiety.Materials and methods: In a double-blind randomized controlled trail, 166 patients with cancer who were candidate for major surgeries were enrolled. The study was carried out in Tehran Imam Khomeini Hospital, 2016. The subjects were randomly divided into two experimental and control groups (n=83 per group). Data was collected using Spielberger questionnaire for anxiety and blood test to measure the serum potassium level. In experimental group 5 mg Chlordiazepoxide was administered while the control group received 5 mg placebo. The medications were taken orally the night before operation and again at the morning of operation. Data was analyzed by Chi-square test, Wilcoxon signed ranks test and paired t-test using SPSS V. 16.Results: Before the intervention no significant differences were seen in serum potassium level and pre-operation anxiety level between the two groups. After the intervention, the variations of these two parameters in test and control groups were -1.83±0.2, -0.01±0.002 and +8.73±3.98, -0.22±0.03, respectively. Only in control group, significant variations were found in K level (P<0.0001) and anxiety level (P<0.001).Conclusion: Chlordiazepoxide was found to be effective in prevention of hypokalemia and overt anxiety increase in patients undergoing surgery to reduce the side effects of anesthesia and surgery.

Background and purpose: Mechanical and chemical canal preparations are not capable of eliminating all microorganisms from dentinal tubules, so using medical intervention is necessary to fulfill this task. The aim of this study was to compare the antimicrobial effect of Carvacrol and Calcium hydroxide against Enterococcus faecalis in different layers of dentin and different time intervals.Materials and methods: An experimental study was performed in which 70 upper anterior single-rooted teeth were extracted and after separating middle of roots, the inner diameter of canals was equalized. After sterilization the specimens were subjected to Enterococcus faecalis suspension and then randomly divided into four groups of 15 each and one control group including 10 samples. Carvacrol was placed in canals for 5 minutes, 48 hours and one week and Calcium hydroxide was placed in canals for one week. Finally, dentinal debris obtained from canal preparation were incubated in culture medium and presence of Enterococcus faecalis was assessed. Statistical analysis was performed using Chi-square test in SPSS.Results: In the inner layer of dentin, success rate of Enterococcus faecalis elimination was 100% for Carvacrol at all time intervals and 80% for Calcium hydroxide after one week. In the middle layer of dentin, the success rate of Carvacrol was 93% after 5 minutes and 87% after 48 hours and one week, but success rate of Calcium hydroxide after one week was 73%. There were no significant differences in antimicrobial effect between the groups (P>0.05).Conclusion: Carvacrol can eliminate Enterococcus faecalis in shorter time intervals compared with Calcium hydroxide.

Background and purpose: Prevention of dental caries is one of the primary goals in dentistry. Application of fluoride decreased dental demineralization but the preventive ability of this fluoride is limited. Nowadays different investigations into dental erosion focused on the preventive effect of laser irradiation. The purpose of this applied study was to assess the effect of diode laser (l=810nm) and CO2 laser treatment in combination with NaF 2.26% varnish on deciduous enamel microhardness.Materials and methods: Seventy-two human mandibular deciduous incisors were polished and randomly allocated to the following treatments (n=12): (1) NaF varnish (2.26% F); (2) NaF varnish+diode laser; (3) NaF varnish+CO2 laser; (4) CO2 laser; (5) diode laser; (6) control group (no treatment). Enamel alterations were determined using Vickers surface microhardness (VMH) testing after treatment and after erosion challenge. For the formation of artificial caries, the samples were immersed in hydrochloric acid, and then enamel alterations were determined again. The mean VMH were tested using analysis of variance and Tukey test.Results: All treatments except CO2 laser improved the hardening of enamel surface (P<0.05) and increased the resistance of samples against demineralization. The NaF+diode laser group had significantly higher surface microhardness value than the other groups (P<0.05). There were no significant differences between diode laser, NaF and CO2 laser+NaF groups in surface microhardness.Conclusion: The surface microhardness was the highest when both laser and fluoride were applied. Therefore, the effect appears to be synergistic; also, diode laser compared with CO2 laser was more effective in improving the hardening of enamel surface.

Background and purpose: Unusual enlargement of nose and pharyngeal (nasopharynx) can disrupt the flow of air through the nose. The aim of this study was to investigate the cephalometric parameters in the upper airways.Materials and methods: A retrospective descriptive study was performed using the digital lateral cephalometric radiographs of 32 adults with class I (CL I) malocclusion and no history of night apnea. The radiographs were obtained from the archives in Qazvin Orthodontics Department of Dentistry School and private clinics. Coefficient of variations and Pearson correlation were calculated in SPSS.Results: There was positive Significant correlation (r=0.761) between tongue length and tongue height, length of the soft palate, and maximum thickness of the soft palate but negative significant correlation was found between tongue length and hypo pharnzhyal air space (r=-0.422) (P=0.01). There was positive significant correlation (r=0.444) between tongue height and length of the soft palate and maximum thickness of the soft palate. Also, there was positive significant correlation between over pharyngeal air space and hypo pharyngeal air space and posterior air space (r=0.551) (P=0.014). There was positive significant correlation between hypo pharyngeal air space and posterior air space, vertical position of vallecula, and horizontal position of vallecula (P=0.017). Posterior air space had a positive significant correlation with horizontal position of vallecula but had a negative significant correlation with length of the soft palate. There was positive significant correlation between length of the soft palate and maximum thickness of the soft palate, and vertical position of vallecula and horizontal position of vallecula.Conclusion: There was no significant difference in cephalometric parameters of the upper air ways in adults in Qazvin with CL I malocclusion. Genetic and environmental effects are the most important factors in these cases.

Background and purpose: Extended spectrum beta lactamases (ESBLs) are important causes of multidrug resistance (MDR) Escherichia coli. ESBL genes are usually located on conjugative plasmids or on integron structures. The aim of this study was to detect ESBLs on class I integron in Escherichia coli isolated from clinical samples.Materials and methods: A descriptive cross-sectional study was performed in which 60 isolates of E. coli were collected from two hospitals in Kerman, Iran during three months. The isolates were identified using standard microbiological and biochemical techniques. Antibiotic susceptibility pattern of isolates was determined by disk agar diffusion method. ESBL-producing E. coli was determined using phenotypic double disc test. Then, Polymerase chain reaction (PCR) was used to detect intI, bla-TEM, bla-SHV, and bla-CTX-M genes. Data analysis was done in SPSS applying Chi-square test.Results: The highest and lowest rates of antibiotic sensitivities in isolated E. coli were found to amikacin and imipenem (3.3%) and ampicillin (66.6%), respectively. Multidrug resistance was detected in 43.3% of the samples. 45% of isolates were identified as ESBL producers. Prevalence of bla-TEM, bla-CTX-M and bla-SHV genes were 74.07%, 69.9%, and 7.4%, respectively. Class I integron was detected in 60% of the isolates.Conclusion: In this study, we observed a significant association between ESBL and class I integron which confirms that ESBLs were located on integron class I and easily transferred into bacteria.

Background and purpose: Recently, natural antimicrobials attracted a lot of attention due to increasing preference of consumers for organic products which are free of chemical additives. The aim of this study was to investigate the antibacterial activity of cinnamaldehyde in combination with acetic and lactic acids against L.monocytogenes.Materials and methods: The antibacterial effects of cinnamaldehyde, acetic and lactic acids were determined using minimum inhibitory concentration (MIC). Fractional inhibitory concentration (FIC) was also used to evaluate the combined antibacterial activity.Results: Based on our results, MIC values for cinnamaldehyde, acetic acid and lactic acid were 0.312, 2.5 and 5 ml/ml, respectively. FIC results showed that cinnamaldehyde combination with the organic acids had no interaction effects (1.0<FIC<4.0).Conclusion: Cinnamaldehyde, acetic and lactic acids were found effective in inhibiting the growth of L. monocytogenes. Meanwhile, organic acids can reduce the required amount of cinnamaldehyde.

Background and purpose: Free radicals have important role in many diseases such as cancer. Antioxidants are powerful scavengers of free radicals and help immune system to remove them. Total antioxidant capacity (TAC) indicates total antioxidant activity in plasma and body fluids. Imbalance between producing free radicals and antioxidant defense leads to oxidative stress in the body and results in cell components damage. Lipid oxidative damage caused by free radicals produces active aldehydes such as malondialdehyde (MDA). This study aimed at investigating the effect of consumption of grape -an antioxidant-rich fruit- on serum levels of MDA and also evaluating the indicators of oxidative stress.Materials and methods: This study was conducted in 43 overweight women in Joorab village, Malayer, Iran, who were selected via simple random sampling in 2015. The relationship between BMI and age were assessed with serum MDA and TAC levels. Considering the significant relationship between MDA and TAC with BMI and age, the study population was divided into three groups: BMI1 (over weight), BMI2 (obese), and BMI3 (sever obesity). MDA and TAC levels were evaluated using HPLC and ELISA in three groups after two consecutive weeks of grape-free diet and consumption of fresh grapes.Results: Grape consumption significantly reduced serum MDA level in BMI2 and BMI3 groups (P<0.05 and P<0.001, respectively) but did not have considerable effect on MDA level among those in BMI1. Also, consumption of grape had no significant effect on TAC level (P>0.05).Conclusion: Grape consumption could reduce oxidative stress markers and improve antioxidant defense.

Background and purpose: Air pollution is one of the most important environmental factors threatening human health that cause short and long term health effects and various diseases. The present study aimed at investigating and quantifying the health consequences associated with exposure to O3, NO2, and SO2 in ambient air in Tehran, 2014, using the air quality (Air Q) model.Materials and methods: A descriptive–analytic study was performed in which hourly data of pollutants were taken from Tehran environmental protection agency and Air Quality Control Company. Data was validated according to the WHO guidelines. Statistical parameters were calculated for quantifying health effects. Then, processed data was converted for Air Q model.Results: The highest cumulative cases of mortality was due to NO2 (n=1274, attributable proportion=2.51). Also, cumulative cases of hospital admission due to chronic obstructive pulmonary disease were attributed to O3 (n=240 cases, attributable proportion=2.54). The number of heart attack cases due to SO2 was 225.Conclusion: According to the growing trend of air pollution, resultant mortality rate, and adverse effects more efficient solutions are required to control and reduce air pollution in Tehran.

Background and purpose: The expression of growth factors, proteolytic enzymes, fibrogenic factors, and cytokines are altered in Helicobacter pylori (H. pylori) infected gastric mucosa. Matrix metalloproteinases (MMP) are a family of zinc-dependent homologous enzymes digesting most of the components of the extracellular matrix and basement membrane and are involved in remodeling and functioning of the biological processes. The purpose of this study was to compare gene expression of matrix metalloproteinase-7 (MMP-7) in patients with H. pylori-infected and uninfected individuals with gastrointestinal diseases.Materials and methods: This study was conducted in 50 H. pylori-negative patients and 50 H. pylori-positive patients being admitted to Shahrekord Hajar Hospital due to gastrointestinal diseases in 2014. The participants’ demographic information was collected and sampling was done. First DNA was extracted, and then PCR was performed to check for the presence of 16sRNA and UreC. The RNA from each sample was also extracted and cDNA was prepared. Afterwards, the expression of MMP-7 was measured by real time-PCR using specific primers and probes.Results: MMP-7 mRNA expression was significantly higher in biopsies of H. pylori-infected patients compared to that in H. pylori-uninfected patients (P<0.0001).Conclusion: Increased expression of MMP-7 can be effective in inflammatory response and development of the disease. It could be used as a key marker for early diagnosis of gastrointestinal diseases and gastric cancer.

Background and purpose: Diazinon is one of the most widely used organophosphate pesticides classified by the World Health Organization (WHO) as “moderately hazardous” Class II. This work aimed at optimizing the electrocoagulation process in removal of diazinon from aqueous environments using response surface methodology.Materials and methods: In an experimental-laboratory study using the D-optimal method, the effects of independent variables including initial concentration of diazinon (10-100 mg/l), applied voltage (20-40 V), reaction time (10-60 min) and pH (3-10) were investigated on removal of diazinon in 30 runs. Process optimization was done by response surface methodology. Analysis of proposed model was also performed using analysis of variance.Results: Diazinon removal in proposed model was statistically significant at 95% confidence level. The model had insignificant lack-of-fit at 95% confidence level (P=0.614). Diazinon removal efficiency was dependent on initial concentration of diazinon, applied voltage, and reaction time. The removal efficiency of diazinon was 84.6% at optimum condition (voltage=20 V and diazinon concentration=100 mg/L).Conclusion: Electrocoagulation process applying current experimental conditions was found to be efficient in removal of diazinon from aqueous solutions. Designing experiments by D-optimal method can optimize the removal of the process and prepare the best conditions for pollutant removal by reducing the number of experiments.

Background and purpose: Today use of unleaded gasoline is increasing in the world which contain abundant amount of aromatic organic carcinogenic compounds. This study aimed at monitoring the temporal and spatial concentration of benzene and toluene as volatile organic compounds in ambient air in Yazd, Iran.Materials and methods: This research, was carried out in different hours of the morning and evening in early fall, 2015. Sampling and measurement of benzene - toluene was done according to 1501 NIOSH guidelines using active sampling and GC-FID. GIS software was used for zoning.Results: The mean concentrations of benzene and toluene in early and late morning-evening hours were 23 and 48.9 mg/m3, 25 and 58 mg/m3, respectively. These values indicates an increase in emissions in last hours of the morning. Also, toluene to benzene ratio (T/B) was 1.3 to 2.1 and 1.2 to 3, showing that benzene and toluene emissions were caused by traffic.Conclusion: The central and southern parts of Yazd were found to be more polluted then northern areas. Also, spatial variations of pollutant concentrations were high, but the temporal trend was low. The correlation between benzene and toluene values in early hours of morning and evening confirmed the temporal and spatial trend. According to T/B ratio, the main cause of benzene and toluene emissions were street traffics and gasoline stations.

Background and purpose: Phytoremediation (constructed wetland) is one of the most appropriate technologies for wastewater treatment. The aim of this study was to evaluate the efficiency of the combined anaerobic and phytoremediation systems for sanitary wastewater treatment.Materials and methods: This experimental study was performed during nine months to measure some parameters including COD, BOD5, TSS, turbidity, total coliform, and intestinal nematode using combined anaerobic and phytoremediation systems. The samples of wastewater were randomly taken twice per month from the influent and effluent of the septic, wetland and control system. The parameters were measured based on both the Bailenger and standard methods for extermination of water and wastewater. The results were then compared with the Iranian effluent standards for irrigation.Results: The results showed that by using the hybrid process of anaerobic and phytoremediation systems, the COD and TSS removal rates reached 80% each and the turbidity and BOD5 removal rates were reported to be 90%. The removal efficiencies of total coliform and intestinal nematode were 99, 999% and 100%, respectively. In this study, the quality of the treated wastewater was found to be acceptable according to the Iranian effluent standards for irrigation.Conclusion: The combined anaerobic and phytoremediation systems can be used as an efficient process for wastewater treatment.

Background and purpose: Spirituality is a complex and multidimensional concept that has cognitive, experiential, and behavioral aspects. According to studies many patients believe that religion and spirituality play important roles in their lives. Usually they expect such considerations to be taken into account by physicians. The aim of this study was to investigate the viewpoints of physicians about spirituality and spiritual care.Materials and methods: A cross-sectional study was performed in 318 physicians working in hospitals affiliated with Qom University of Medical Sciences in 2013. Data was collected by a questionnaire consisting of demographic information and measures of spirituality and spiritual care. The validity and reliability of these scales were previously approved.Results: The mean age of the physicians was 41.51±8.89 years and the majority were married (83%). Amongst the participants 73% were male and 82.7% were general practitioners. The perception of spirituality and spiritual care was desirable in 2.35%, highly satisfactory in 10.1%, and lower than average in 54.7% of the cases. The viewpoints of physicians towards spirituality was significantly correlated with spiritual care (P<0.05).Conclusion: Based on these findings, doctors’ attitudes towards spirituality and pastoral care was undesirable. Pastoral care trainings are recommended for young physicians and those with lack of experience.

Background and purpose: In recent years, the incidence of cancers has increased in the world. Therefore, many researches have focused on new strategies for treatment of cancers. Previous studies showed that quinolone antibacterials can inhibit human topoisomerases at high concentrations and can be considered as potential cytotoxic agents. On the other hand, 5, 7-dibromoisatin is a cytotoxic agent and inhibits tubulin polymerization. Accordingly, a series of ciprofloxacin-isatin conjugates were prepared as potential cytotoxic agents.Materials and methods: Isatin was dibrominated by bromine in refluxing ethanol. The 5, 7-dibromoisatin was reacted with ciprofloxacin in the presence of paraformaldehyde to produce N-Mannich base of ciprofloxacin. Furthermore, 5, 7-dibromoisatin was reacted with 1-bromo-2-chloroethane to give N-(2-chloroethyl)-5, 7-dibromoisatin. The latter compound was reacted with ciprofloxacin to afford related conjugate analog containing two carbons linker. All compounds were purified by extraction and crystallization. The structures of compounds were assigned by IR and NMR spectroscopy.Results: Conveniently, several new conjugates of ciprofloxacin and isatin containing methylene or ethylene linker were prepared. The isolated yields for final compounds were 23 to 34%. In the preparation of final compounds with methylene linker (compounds 4a and 4b), ethanol was found to be the best solvent while N,N-dimethylformamide (DMF) was an appropriate solvent for preparation of compound 4c, bearing an ethylene linker. The final products were re-crystallized from DMF or DMF-water.Conclusion: The conjugate analogs of ciprofloxacin and isatin derivatives can be obtained using an appropriate and convenient method. The designed compounds have both pharmacophoric motifs of quinolones and isatin and potentially can be considered as new cytotoxic agents.

Background and purpose: Energy recovery from waste is an appropriate method for waste management and energy production from food waste. Energy production through waste incineration produces significant emission which is a critical threat for environment. Anaerobic digestion of the waste is a suitable way to produce clean energy. This study aimed to investigate the anaerobic digestion from food waste using microwave pretreatments in different levels of power and time that eventually increase anaerobic digestion and produce methane.Materials and methods: The food waste was collected from the restaurant in Bu-Ali Sina University and microwave (MW) treatment was performed before feeding reactor. Pretreatment process of the food waste was done by a domestic MW (P=450 and 630 W) in different radiation times (100, 200 and 300 s). Reactors at mesophilic temperature (37oC) were launched for 15 days and SCOD and TCOD values were measured before loading and at the end of the tests. Using MATLAB software, the cumulative methane values were fitted on exponential, modified Gompertz and logistic models and the best model was determined in terms of the highest R2 and lowest RMSE and SSE amounts.Results: Based on the results, the best performance of anaerobic digestion, the maximum percentage of SCOD/TCOD% and the highest rate of methane production were obtained in 630 W microwave power and 300 s exposure time. Also, cumulative methane production was fitted using exponential, modified Gompertz and logistic models.Conclusion: Increasing the power and exposure time enhanced solubility and the SCOD/TCOD% of the food waste. By increase in SCOD/TCOD% the daily biogas and methane productions also increase. The TSremoved and VSremoved values increase when the microwave power and exposure time increased. Also, the modified Gompertz model is a comprehensive and flexible model that is well fitted the experimental data and modified Gompertz model results in the highest R2 value and the lowest RMSE and SSE.

Background and purpose: The prevalence of antibiotic resistant P. aeruginosa strains became a major problem in treatment of burn patients. The aim of this study was to determine the frequency of blaIMP, blaVIM and oprD genes among P. aeruginosa isolated from hospitalized burn patients in Tehran Shahid Motahari Hospital, Iran.Materials and methods: This descriptive study was performed on P. aeruginosa strains isolated from hospitalized burn patients in Shahid Motahari Hospital. Antibiotic resistance phenotypic pattern was evaluated by Kirby Bauer disk diffusion method. The phenotypic investigation of metallo-beta-lactamase (MBL) producers was evaluated by Combined Diffusion Tests Disk (CDDT) method. The prevalence of blaIMP-1, blaVIM-1 and oprD genes was investigated by PCR and sequencing methods.Results: From 100 P. aeruginosa strains, 95 isolates were resistant to imipenem and meropenem which 81 were MBL producing strains. Among all isolates, 13 carried blaIMP-1 gene, whereas all of strains were negative for blaVIM-1 gene. In this study we detected two insertion sequence (IS) including ISPpu21 and ISPa1328 among PCR products that were larger than expected.Conclusion: The P. aeruginosa infections could be prevented and controlled by identification of drug resistance patterns and beta-lactamases.

Background and purpose: Psychological factors play a major role in causing and aggravating medical conditions. This study aimed at cognitive emotion regulation strategies and psychological distress in patients with AIDS and normal individuals. Materials and methods: A causal comparative study was performed in which two groups of AIDS patients and normal individuals (n=43 per group) enrolled. The participants were selected using purposive sampling. The scale of depression, anxiety, stress (DASS21) and the short form of cognitive emotion regulation (CERQ-P) was used. Data was analyzed in SPSS applying one-way ANOVA. Results: Compared with normal individuals, people with AIDS used higher levels of maladaptive strategies and to a lesser extent used adaptive strategies (P<0.01), they also had higher levels of anxiety, depression and stress (P<0.01).Conclusion: Maladaptive cognitive emotion regulation in patients with AIDS leads to severe psychological problems. Also, high levels of psychological distress in these patients could intensify the course of disease, cause low response to treatment and increase the risk of suicide, therefore, psychological interventions alongside medical interventions are required to reduce these problems.

Background and purpose: Data in death certificates acts as a basis in epidemiological studies. Community health statistics broadly originates from necrology, therefore, underlying cause of death is highly important. The aim of this research was to determine the extent of ambiguous symptoms, signs, and causes in mortality certificates.Materials and methods: A retrospective descriptive analysis was conducted in which mortality certificates issued by hospitals affiliated with Mazandaran University of Medical Sciences in 2010-2014 (n=20233) were investigated. A checklist was used to collect the information. Data was then analyzed in SPSS V.18. Chi-square test was applied to determine the significance of relationship.Results: Twenty three percent of death certificates reported ambiguous symptoms and causes as the cause of death. Vague and poorly defined causes were more common in private hospitals (33.7%) and in those older than 60 years of age (51%). Based on the findings, the less patients stayed in hospital, the more unclear causes were recorded.Conclusion: Ambiguous symptoms and causes are the second cause of death on death certificates. Such data is worthless in health planning, therefore, it is essential to take measures for training the doctors and launching a smart system of mortality registration.

Histiocytosis is a term applied to a group of rare disorders of the reticuloendothelial system. Eosinophilic granuloma is the most benign and localized of the three Langerhans cell histiocytosis (LCH) entities that could be solitary or multiple. In 2015, the incidence of the disease was reported to be 1 in 9100000. Eosinophilic granuloma can affect almost any bone, but commonly involves the mandible when the jaws are affected. Conventional treatment of LCH includes surgery, radiotherapy, chemotherapy and steroid injections (alone or in combination). Spontaneous regression of localized disease has also been reported. We report a 30-year-old man with the LCH solitary eosinophilic granuloma in the mandible. The patient had lost all the mandibular teeth because of a misdiagnosis with periodontitis and osteomyelitis.

Sickle cell disease is the most common type of hemoglobinopathies in the world that is caused by abnormal beta globin chain in hemoglobin. The disease is usually diagnosed in the first decade of life. Bone involvement is one of the most common clinical manifestations both in the acute setting (painful vaso-occlusive crises), and/or as a source of chronic disability (such as avascular necrosis). This paper introduces an old patient with advanced skeletal manifestation due to this disorder. A 66-year-old man who was opium abuser was visited by a rheumatologist for lower limbs pain, and fatigue from one year ago. The patient had severe anemia, and X-ray revealed diffuse osteolytic changes without sharp border in pelvis and femur and joint space narrowing. Involvement of thoracolumbar vertebras were seen as codfish vertebra appearance. In peripheral blood smear, sickle cell and target cells accompanied by hypochromia and platelets aggregation were detected. The hemoglobin electrophoresis was compatible with sickle-b+ thalassemia. In old patients with anemia and osteolytic lesions with unknown reason, evaluation of hemoglobinopathies, especially sickle cell anemia is suggested.

Langerhans cell histiocytosis (LCH) is a rare, proliferative disorder which is characterized by proliferation of pathological Langerhans cells within different organs. In 90% of cases the head and neck are affected. In this article, we report a 2.5-year-old boy with LCH who was referred to the pediatric department of Babol Dental School, with a chief complaint of fever, mucosal ulceration, gingival necrosis and tooth mobility. Our clinical diagnosis was Langerhans cell disease. In panoramic radiography, multiple well-defined radiolucencies were observed in both maxilla and mandible. Histopathological examination confirmed our diagnosis. The patient underwent chemotherapy with vinblastine for one year. Oral manifestations are common findings in LCH, therefore, dentist plays an important role in both diagnosis and management of this disease.

Background and purpose: Tick paralysis is a relatively rare and fatal disease caused by some species of blood- sucking ticks of Ixodidae family including Ixodes scapularis and Dermacentor andersoni. This disease is characterized by ascending acute flaccid paralysis but could be misdiagnosed with other neurological diseases especially, Guillain-Barré syndrome because of similar clinical presentations. In this review we aimed to introduce tick paralysis to raise awareness on differential diagnosis of tick paralysis with other neuropathies.Materials and methods: A narrative review study was performed in which data was collected without time and language limits from international electronic databases including: Pub Med, Web of Science, Google Scholar, Elsevier (ScienceDirect, Scopus), Lilacs, and Iranian scientific databases including: Barakatkns, SID, Civilica, Magiran, and Medlib using appropriate keywords.Results: Tick paralysis mainly affects children (usually girls). The paralysis is caused by toxin in the saliva of hard ticks and if blood feeding is continued for a long time, respiratory failure and probably death may occur. The absolute therapy of tick paralysis is simply removing ticks that are attached to the patient’s body. Improvement in symptoms is usually observed within 24 hours to a few days after removing the tick/s.Conclusion: Finding the tick/s and symptoms of paralysis are the main characteristics in diagnosis of tick paralysis. Since the disease is caused by the toxin in tick saliva, therefore, antibiotics are not effective in its treatment. Also, due to frequent misdiagnosis of the disease, awareness of the healthcare providers can play a considerable role in early detection, treatment, preventing additional costs of laboratory examinations, and ultimately prevent death.

Allergic Bronchopulmonary Aspergillosis (ABPA) is a hypersensitivity response to Aspergillus antigens in patients with asthma or cystic fibrosis (CF). The inhalation of spores from the environment is followed by growth of hyphae in the mucus of the bronchial tree and stimulates an immune response involving Th2 CD4+ T cells and IgE and IgG antibodies. Although diagnostic procedure for ABPA is a big challenge, serological marker (measurement of IgE antibody) for the diagnosis of ABPA is chosen in clinical. However, cross-reactivity may also occur between crude fungal extracts. Therefore, combination of clinical, biological and radiological criteria with molecular-based allergy can solve this problem. Although, the mainstay of treatment for ABPA is corticosteroids followed by antifungal regimes, but treatment is dependent on the ABPA stage with asthma control, prevention and treatment of acute disease, and preventing the progression of bronchiectasis. The current review paper presents a comprehensive overview of the allergic bronchopulmonary aspergillosis based on diagnostic and therapeutic aspects.