JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2018 | Volume:28 | Issue:164 |Papers Count:21

Background and purpose: Ischemia-reperfusion injuries (I/RI) are the major causes of liver failure after various types of liver surgeries، particularly liver transplantation. Reactive oxygen species (ROS) are the major causes of such injuries، therefore، antioxidant therapy to attenuate hepatic lesions is preferred. We aimed to evaluate the effects of silibinin، a potent radical scavenger، on liver damages and endothelial and inducible nitric oxide synthase (eNOS and iNOS) genes expression after liver I/R. Materials and methods: In this experimental study، the rats were divided into four groups (n=8 per group). Group1 Vehicle: the rats underwent laparotomy and received DMSO10%، Group 2 SILI: the animals received silibinin alongside laparotomy، Group3 I/R: the rats received DMSO10% and subjected to liver I/R procedure، and group 4 I/R+SILI: this group received both silibinin and liver I/R simultaneously. Silibinin (50 mg/kg I. P) was administered twice in all rats. After 1 h ischemia and 5 h reperfusion، blood samples were collected to evaluate serum AST and ALT levels and liver sections were taken to analyze the eNOS and iNOS gene expressions and histological examinations. Results: There were no significant differences in all parameters between Vehicle and SILI groups (p>0. 05). But serum AST and ALT increased significantly in I/R group compared with those in vehicle group. Treatment with silibinin could considerably reduce these markers. Histological damages during I/R improved by silibinin. The iNOS gene was found to be overexpressed whereas eNOS expression decreased in I/R group compared with those in the vehicle group. Silibinin treatment could decline iNOS expression but could not significantly affect eNOS expression (p>0. 05). Conclusion: Silibinin protects liver from I/RI. It may decrease iNOS adverse effects by suppressing its expression.

Background and purpose: Estrogen hormone is a physiological regulator of breast tissue proliferation and changes in its signaling pathways، including the alpha-estrogen receptor، occurs during breast cancer and its progression. Single-nucleotide polymorphisms (SNPs) in genes can lead to differences in cancer susceptibility and response to treatment in different populations. In the present study، we investigated rs2234693 C/T single-nucleotide polymorphism in ESRα gene in breast cancer patients and healthy population in west of Mazandaran province، Iran. Materials and methods: A case-control study was performed in 91 healthy women without family history of breast cancer and 71 women with breast cancer admitted to oncology department in Ramsar Imam Sajjad Hospital between April and September 2017. Peripheral blood (3 ml) was taken from the subjects and stored at-20° C. The PCR-RFLP method was used to determine the distribution of rs2234693 polymorphisms. Results: The incidence of breast cancer in individuals with homozygous TT genotype was significantly higher (p<0. 001) compared to those with CT and wild CC. Moreover، individuals with T allel are at significantly higher and increased risk for breast cancer (OR =2. 207، 95%CI =1. 40-3. 48، p= 0. 001). Conclusion: To the best of our knowledge، this study for the first time suggested that T allele of rs2234693 C/T polymorphism might be a leading allele that cause increased breast cancer susceptibility in west of Mazandaran province.

Background and purpose: Increasing resistance to Quinolones in Escherichia coli and Klebsiella pneumonia in Sari، has caused many problems in treatment. Mutation in gyrA gene lead to changes in amino acids and resistance against Fluoroquinolones in E. coli and K. pneumonia. This study aimed at identifying remarkable mutations in E. coli and K. pneumonia isolates using PCR-SSCP analysis. Materials and methods: Antibiotic sensitivity test (ciprofloxacin، nalidixic acid) was performed using Agar Disk Diffusion method. Resistance to fluoroquinolones was confirmed by E-test. (MIC experiment). We used PCR-SSCP method to detect mutation in gyrA (ser83 – asp 87) genes. Then، the PCR products were randomly sequenced. Results: From 103 isolates، 65 (63. 2 %) were E. coli and 38 (36. 8%) were K. pneumoniae. In all E. coli isolates resistant to Ciprofloxacin، at least one mutation was observed. Also، in all K. pneumoniae samples resistant to Ciprofloxacin، at least one mutation was seen and in 14 samples two mutation points were observed، but in 5 samples that were sensitive to Ciprofloxacin no mutation was observed. Conclusion: This study showed that the mutation in gyrA genes is closely related to quinolones resistance. High prevalence of quinolones resistance in E. coli and K. pneumoniae isolates requires more appropriate infection control programs.

Background and purpose: Using practical and non-invasive methods to improve the adequacy of dialysis (i. e. Kt/V) can increase the quality of life and decrease the mortality and morbidity rate in patients under hemodialysis. This study was conducted to investigate the effect of intermittent normal saline bolus on adequacy of dialysis. Materials and methods: In this randomized controlled cross-over clinical trial، 51 patients were chosen based on inclusion criteria and were randomly assigned into two groups. Before the intervention، the Kt/V and Urea Reduction Ratio (URR) of the last session of dialysis (baseline) were measured in all patients. The control group were dialyzed conventionally (heparinized dialysis)، but the intervention group received 100 ml normal saline bolus every hour، within three times. In three subsequent sessions، as a washout period، all patients received conventional hemodialysis. Then the patients were swapped and all steps were repeated. Results: Before the intervention، there were no significant differences between the two groups in age، sex، duration of dialysis، type of vascular access، adequacy of dialysis، and Urea Reduction Ratio (P>0. 05). Compared with baseline، the Kt/V and URR mean values increased by 16 and 8% in intervention group، respectively (P<0. 01) but these values decreased in control group. In addition، findings revealed significant differences in Kt/V and URR mean values between the two groups after using normal saline bolus intermittently (P< 0. 01). Conclusion: Using intermittent normal saline bolus during hemodialysis improves adequacy of dialysis.

Background and purpose: Diabetes is one of the most common and chronic diseases in the world. The prevalence and incidence of this disease is rising in most societies and also in Iran. New research suggests that added sugar، especially fructose، is the main trigger for diabetes and pre-diabetes، even more potent than other carbohydrates. This study aimed to determine the effects of low fructose diet on glycemic control in patients with type 2 diabetes. Materials and methods: In a randomized clinical trial، 40 patients with type 2 diabetes (40-70 years of age) were recruited from Qazvin Diabetic Society. Patients in treatment and control group followed a low fructose diet with at last 12 g glucose per day and regular diabetic diet for 8 weeks، respectively. At the beginning of the study and at the end of week eight، the anthropometric، fasting blood glucose، insulin، HOMA-IR and HbA1c indices were measured. Results: The mean age and duration of diabetes in patients were 53± 7. 5 and 8± 2، respectively. No significant differences were observed between the two groups in qualitative variables (sex، smoking، and medications) and quantitative variables (age، duration of diabetes، and body mass index) at baseline. Anthropometric indices were improved in this study but the changes were not significant. At the end of the study، fasting blood glucose levels decreased in both groups but there was no significant difference between the two groups (P= 0. 143). The mean HbA1c changes at the end of the study were significantly greater in the intervention group (P= 0. 005) but the changes in other glycemic factors were not significantly different between the two groups. Conclusion: It seems that patients with type 2 diabetes have better glycemic control with limited use of fructose.

Background and purpose: Plantar fasciitis is the most common cause of metatarsus pain. The purpose of this study was to compare improvements in pain and function in patients treated with Extracorporeal Shock Wave Therapy (ESWT) and dry needling. Materials and methods: In a randomized controlled clinical trial، 72 patients with plantar fasciitis were randomly divided into two groups. The first group was treated with ESWT and the second group was treated by dry needling. Performance variables based on Foot Function Index (FFI) and pain based on Visual Analogue Scale (VAS) were evaluated before treatment، and 4 weeks and 8 weeks after treatment using SPSS V16. Results: There were 72 patients (mean age: 44. 1± 9. 4) mainly females (n=54). Following 4 weeks and 8 weeks، both methods significantly reduced the pain index measured by VAS and FFI score compared with those before treatment. No significant difference was found between the two groups after 4 weeks of treatment in pain index measured by VAS and FFI score (P= 0. 668 and P= 0. 011، respectively). But، 8 weeks after the treatment، the rate of pain reduction، and FFI increased significantly in the group treated by dry needling (P= 0. 011 and P=0. 013). Conclusion: Both ESWT and dry needling were found to be effective in treatment of plantar fasciitis، but dry needling showed to be more efficient in 8 weeks after treatment.

Background and purpose: Physical restrictors are commonly used in intensive care units (ICUs). Lack of knowledge on the application of these tools leads to inappropriate care. Current study was designed to determine the effect of nursing trainings on the use of physical restrictors and the rate of their correct application in patients admitted to ICUs. Materials and methods: In a quasi-experimental study (2016)، the rate of application of physical restrictors and their correct use in ICUs were recorded. The nurses were selected from two different hospitals forming the intervention group and control group. The nurses in one hospital received trainings on the correct application of physical restrictors in ICUs. After the intervention، the data was compared within and between the intervention group and controls (the nurses in other hospital with no particular education during the study). The data was recorded 15 days after the intervention and analyzed in SPSS 18. Results: The rates of application of physical inhibitors before the study in the intervention group and control group were 49. 8% and 49. 7% which were 37. 6% and 49. 7%، respectively after the intervention (p<0. 001). The values for correct use of physical inhibitors in intervention and control groups were 34% and 37. 3% before the intervention and 37. 9% and 37. 3%، respectively after the intervention. (p<0. 001). Conclusion: Training the nurses on the use of physical restrictors could reduce their rate of application and increase their correct use in ICUs which should be further considered by authorities.

Background and purpose: Serum creatinine and its derived formulae in estimating glomerular filtration rate is not accurate in cirrhotic patients because of decreased muscle mass and secretion and excretion functional impairment of liver. This study aimed at investigating the accuracy of serum cystatin C in determining GFR and examining the relationship between synthetic and excretory liver function with glomerular filtration rate in cirrhotic patients. Materials and methods: In this cross-sectional study، 35 patients with cirrhosis and 35 age and sex matched healthy controls enrolled. Serum creatinine، LFT، FBS، LDL، HDL، cholesterol، triglycerides، albumin، globulin، and cystatin C and also 24-hour urinary urea and creatinine were measured. GFR was estimated by three measurement methods and the relationship between GFR and Child score was evaluated. Results: The mean age of participants was 39. 15± 13. 93 years and male patients included 48. 57%. The most common cause of cirrhosis was autoimmune cirrhosis. GFR based on creatinine in two different formulas was higher than that in control group but the GFR based on cystatin C was significantly lower in cirrhotic group (p<0. 001). The secretory and excretory functions of liver were not significantly correlated with GFR in cirrhotic patients (p>0. 05). Correlation coefficient between GFR (based on cystatin C) and Child-square was 0. 199 (p= 0. 251). Conclusion: GFR based on cystatin C is more accurate in cirrhotic patients. On the other hand، there was a moderate negative correlation between GFR (based on cystatin C) and Child-square that can be helpful in prediction and early detection of renal dysfunction in cirrhotic patients.

Background and purpose: Cardiovascular disorders (CVDs)، including coronary artery disease (CAD) are amongst the pioneer causes of mortality and morbidity worldwide. Materials and methods: In this cross-sectional study، the patients were selected from the Mazandaran heart center whose CAD was confirmed by angiography. Demographic and clinical data were recorded in a checklist. Results: The patients included 55% males (mean age: 59. 9± 10. 2 years) and 45% females (mean age: 57. 1± 6. 8 years) (P=0. 14). The prevalence of coexistent risk factors was as follows: hypertension 57%، diabetes 46%، dyslipidemia 40. 4%، and smoking 20. 2%. Distribution of risk factors by gender was as follows: hypertension in 51% of males and in 65% of females (P>0. 05)، dyslipidemia in 34. 7% of males and 47. 5% in females (P>0. 05)، diabetes in 32. 6% of males and 62. 5% of females (P=0. 005)، obesity (BMI≥ 30) in 20. 4% of males and 40% of females (P=0. 043)، and smoking was observed in 36. 7% of males (P<0. 001). Men were diagnosed with 2 or 3-vessel coronary artery disease، while the women mainly had the single-vessel disease (P=0. 016). Conclusion: High prevalence of preventable risk factors was seen in patients studied، so، appropriate training، promotion of healthy lifestyle، and CVD screening in high-risk individuals could be of great benefit in reducing the burden of CAD diseases. Keywords: coronary artery disease, angiography, risk factors

Background and purpose: Avoidance and cognitive fusion are two components of psychological inflexibility and are the main concepts of Acceptance and Commitment Therapy (ACT). The purpose of this study was to evaluate the psychometric properties of the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8). Materials and methods: A descriptive cross-sectional study was conducted in 300 students in Kashan، Iran who were selected by cluster sampling. The Avoidance and Fusion Questionnaire for Youth (AFQ-Y8) and the Revised Children's Manifest Anxiety Scale (RCMAS) were administered to collect the data. The factor structure of the questionnaire was evaluated using exploratory and confirmatory factor analysis. Also، the convergent validity with RCMAS، test-retest reliability، and internal consistency of this questionnaire were examined. Results: Exploratory factor analysis indicated one factor called psychological inflexibility. Confirmatory factor analysis confirmed the one factor model of the questionnaire (RMSEA 90% CI =0. 00-0. 07). Also، the convergent validity with RCMAS was found to be good (r = 0. 60، p<0. 001) and the internal consistency and test-retest reliability (4 weeks interval) were 0. 71 and 0. 65، respectively. Conclusion: AFQ-Y8 is an appropriate tool with acceptable psychometric properties to measure the psychological inflexibility of adolescents in Iran.

Background and purpose: Hierarchical decision-making bodies in universities include the board of trustees، the head of university، the board of directors، and the university council. The aim of this research was to determine the function of the board of trustees of state medical sciences universities in Iran during five different periods; 1991 to 2016. Materials and methods: In this descriptive-analytic research we investigated all the directives approved by independent board of trustees in state medical sciences universities affiliated with Iran Ministry of Health and Medical Education in five periods. Results: The number of meetings held by board of trustees in 47 universities (average of 37 universities per year) was 1999 in which 32680 directives approved. The average number of meetings per year in each board of trustees was 2. 08، the lowest was in the second period (1. 12) and the highest was in the fifth period (3. 04). The average numbers of directives approved in the first and second periods were 10، and in the third، fourth، and fifth periods were 17، 20، and 16 per session، respectively. Conclusion: Based on the number of meetings per year and the number of directives approved in every meeting، the function of board of trustees from the highest to the lowest was in the fourth، fifth، third، first، and second periods. Compared with the function of type 1 and type 2 universities، the function of type 3 universities was found to be higher. The functional pattern in most tasks and those within the authority of board of trustees during the first 16 years was considerably different between the Ministry of Health and Medical Education and the Ministry of Science، Research and Technology.

Background and purpose: Perceptions and experiences of women about menopause are remarkably influenced by sociocultural context. Awareness of this issue could help health system policy makers to develop appropriate care plans for menopausal women in transition. This study aimed to explore the perceptions of Iranian women about menopause. Materials and methods: This exploratory qualitative study was conducted on 27 women aged 42-55 years old in Gonabad and Mashhad، Iran، between May 2014 and July 2016. Semi-structured in-depth interviews were conducted until data saturation was achieved. Conventional content analysis was done using the method proposed by Graneheim & Lundman (2004) in MAXQDA 2007. Results: Findings showed an overarching theme entitled “ In the limbo of fear and hope" consisting of three categories and 15 sub-categories. The categories included: 1) feeling of freedom due to cessation of menstruation، 2) concerns associated with occurrence of menopause، and 3) divergent interpretations of menopause. Conclusion: The main theme in this study was “ In the limbo of fear and hope” which showed that the perceptions of women about menopause vary in a wide continuum of worry and peace. It is believed that changes in social beliefs toward menopause can reduce concerns and fears of women in menopausal transition.

Background and purpose: Osteoarthritis of the hand is one of the most prevalent joint diseases in older adults. Hand has a key role in daily activities، therefore، its impairment causes disability and reduces independency. This study aimed to compare the effectiveness of Kinesio taping and hand exercise on pain، range of motion، and grip strength in patients with hand osteoarthritis. Materials and methods: In this experimental study، 20 patients with hand osteoarthritis were randomly assigned to either Kinesio taping group or exercise group. Visual analogue scale، goniometer and dynamometer measurements were used to assess the severity of pain، range of motion، and grip strength، respectively، at baseline and two months after the intervention. In Kinesio taping method the tape was applied only on wrist extensor muscles and thumb. In other group، conventional rehabilitation interventions were used. Results: In this study، grip strength and range of motion improved after intervention in both groups، but pain intensity was significantly less in the group applying Kinesio taping (P= 0. 001). More improvements were seen in grip strength in exercise group. There were significant differences between the two groups in pain and grip strength (P= 0. 043، P= 0. 028، respectively). Conclusion: In current research، Kinesio taping and hand exercise showed positive effects on pain، range of motion، and grip strength in patients with hand osteoarthritis.

Background and purpose: Continuous use of computer games can cause anxiety and depression in adolescents. The aim of this study was to investigate the relationship between gaming and anxiety and depression in male students. Materials and methods: In this correlational study، the research population included all high school students in Sari، Iran 2014-2015. The samples were selected based on Morgan table using cluster sampling (n=330). They were divided into three groups: a control group (group I) who did not play at all or were not familiar with computer games and two test groups who played at least 2 hours a week (group II) and played more than two hours a week (group III). Subjects responded to SCI-90-R and a demographic questionnaire. Data analysis was done in SPSS V20. Results: There was a significant relationship between the level of gaming، anxiety، and depression (P<0. 05). In other words the students who were more engaged with computer games showed significantly higher levels of anxiety and depression (P<0. 05). Conclusion: In this study، increased hours of computer games was associated with increased anxiety and depression، therefore، in order to maintain mental health and preventing psychological problems، parents are suggested to control the time of their children gaming.

Background and purpose: Taurine has many biological functions such as antioxidant and anti-inflammatory activities and acts as a neurotransmitter. But its effects on the tau phosphorylated protein levels require further studies. The aim of this study was to evaluate the protective and therapeutic effects of taurine on the level of tau phosphorylated protein in the hippocampus of rats treated with scopolamine. Materials and methods: In this research، 72 male Wistar rats were randomly divided into three groups: control، protection، and treatment groups. Protective and therapeutic groups were treated with different doses of taurine (25، 50، 100 mg/kg/day) for 14 days before or after injection of scopolamine (3 mg/kg). After the end of treatment، the extract of homogenized hippocampus tissue was collected to measure the level of tau phosphorylated protein using ELISA technique. Results: Protective injection of different doses of taurine significantly reduced the level of tau phosphorylated protein in the hippocampus compared to that in the protective sham group (p<0. 001). Therapeutic injection of taurine at 50 mg/kg significantly decreased the level of tau phosphorylated protein compared with that of the therapeutic sham group. Conclusion: Protective and therapeutic injection of taurine can reduce the tau phosphoryl protein levels in the hippocampus of rats before or after the injection of scopolamine.

Background and purpose: Tuberculosis is a contagious disease caused by mycobacterium tuberculosis. Approximately 30% of the world's population is infected، 5-10% of whom develop active tuberculosis. The aim of this study was to determine the tuberculin skin test conversion. Materials and methods: A cross-sectional study was conducted in 114 staff working in Qaemshahr Razi Hospital، 2015-2017. Demographic characteristics and the results of tuberculin skin test (TST) were recorded in a checklist. Data analysis was done in SPSS V20. Results: The participants included 15. 8% males and 84. 2% females (mean age: 29. 42± 5. 03). Among the subjects، 33% had latent tuberculosis. TST was positive in 11. 4% in first evaluation and 36. 84% had positive TST in the second assessment. TST seroconversion was observed in 25. 44%، in 61. 4% the working experience was more than 10 years، and 61. 5% worked in infectious department. There were significant associations between the positive result of TST and age، gender، and working experience (P=0. 002، P=0. 021، and P=0. 01، respectively). We observed significant differences in the results of TST between the first and second evaluation (P<0. 0001). Conclusion: Hospital staff are at high risk for developing tuberculosis due to direct contact with tuberculosis patients. Due to TST seroconversion they should be screened for TB annually. Isolation of patients with pulmonary tuberculosis and practical trainings should be considered in order to prevent infection in staff. Personal protective equipment is also needed for individuals working in hospitals.

Background and purpose: Psychological issues are of great importance in people with diabetes، so، this study was conducted to determine the association between mental health and sexual function and sexual satisfaction. Materials and methods: In this cross-sectional study، the research population included all males with diabetes type 2 in Kermanshah، Iran 2016. A sample of 330 patients was selected. Data was collected using the Larson Sexual Satisfaction questionnaire، Male Sexual Function Index، the Depression Anxiety Stress Scale (DASS)، and a demographic questionnaire. Results: The mean age of patients was 55. 42± 9. 28. The mean scores for sexual satisfaction and sexual function were 61. 67± 10. 17 and 35. 65± 19. 21، respectively. Sexual satisfaction was at a poor level. The results showed a negative relationship between sexual satisfaction and sexual function and depression، anxiety، and stress (P<0. 001). Sexual function and satisfaction were different among different ages and educational levels. Conclusion: According to current results، sexual function and sexual satisfaction are associated with psychological factors.

Background and purpose: Early treatment of thrombolysis can reduce mortality in patients with myocardial infarction، so، this systematic review and meta-analysis aimed to compare the effect of pre-hospital thrombolysis and in-hospital thrombolysis on short-term mortality in patients with myocardial infarction. Materials and methods: Systematic search was conducted in electronic databases including Pubmed، Web of Science، Cochrane، and Embase without time and language constraints using related keywords. All articles were exported to EndNote. In initial search، 223 articles were found but finally 10 articles were selected for quality assessment، which was performed using the JADAD standard checklist for interventional studies and the Newcastle Ottawa Scale checklist for cohort studies. Comprehensive Meta-Analysis software was used for data analysis. Results: The total samples size was 4291 in the pre-hospital group and 4، 730 in the in-hospital group. Three clinical trials and all three cohort studies were found to have a good quality. Meta-analysis showed that thrombolytic therapy at the onset of symptoms and prior to patient's transfer to hospital could reduce mortality by 36% (OR= 0. 64 CI 95%: 0. 45-0. 91). Conclusion: Pre-hospital thrombolysis by emergency technicians can reduce mortality in patients with myocardial infarction.

The gastrointestinal system harbors various microorganisms، known as gut microbiota. Increase in prevalence of inflammatory bowel disease (IBD) in developed countries is associated with changes in the environment، such as decrease in incidence of parasitic infections، especially helminths، and changes in the intestinal flora. Probiotics are useful microbiota for human health. The parasitic worms (helminths) have evolved over the years with their host. Several studies have investigated the capability of helminths and probiotics to alter or control host immune responses in view of the fact that these organisms have immunomodulation effects. Given the contradictory results، further broad studies are needed to confirm the role of probiotics and helminths in the treatment of IBD.

It is now more than three decades since the first live birth from oocyte cryopreservation. At present، oocyte cryopreservation has become a major component of Assisted Reproductive technologies (ART). Across the world، there is an increasing demand، especially for so-called ‘ social egg freezing’ that allows women to preserve their fertility in anticipation of age-related fertility decline. The purpose of this review article was to investigate the current status of oocyte cryopreservation، common techniques، success rate، clinical applications، the rise of elective oocyte cryopreservation، and future implications. A systematic search was performed using Web of Science and PubMed databases for articles published between January 1980 and December 2015. Keywords used included ‘ egg freezing’ ، ‘ oocyte freezing’ ، ‘ oocyte cryopreservation’ ، ‘ oocyte vitrification’ ، and ‘ fertility preservation’ . Recently، due to many reasons، including resolving age-related infertility in women the success rate of oocyte cryopreservation by vitrification has risen and IVF pregnancy rates are now similar to those achieved by fresh oocytes، therefore a remarkable increase is seen in oocyte cryopreservation cycles around the world. Oocyte cryopreservation (vitrification)، especially social egg freezing is one of the best choices in women and girls with cancer who are at risk of losing fertility due to chemotherapy and radiation therapy، reproductive problems، premature ovaries، and also in women with chronic illnesses.