Journal of Mazandaran University of Medical Sciences
Year:2020 | Volume:30 | Issue:188|Papers Count:20

Background and purpose: Piperine as the main alkaloid of black pepper has antioxidant and neuroprotective properties, so, it is an appropriate candidate to be studied in animal models of multiple sclerosis. This research aimed at investigating the effect of pretreatment with piperine on spatial memory, oxidative stress, and myelin repair gene markers in local demyelination model. Materials and methods: Adult male Wistar rats (200– 220 g) were studied in four experimental groups (n=8 per group). Demyelination was induced by bilateral injection of lysolecithin (LPC) into the CA1 region of the hippocampus. Piperine was injected intraperitoneally at 5 mg/kg for two weeks before induction of demyelination until the end of the experiment. The effect of piperine on spatial memory was assessed by Morris water maze. The gene expression analysis on iNOS, Nrf2, HO1, and MBP was done using qPCR. Total antioxidant capacity in the hippocampal tissue was measured by FRAP biochemical assay. Results: Pretreatment with piperine significantly reduced escape latency and swimming distance and increased time spent in target quadrant in Morris water maze test (P<0. 0001). In the Piperine pretreatment group, the expression level of iNOS was significantly lower than that in the LPC group. But the expression levels of Nrf2, Hmox-1 and MBP significantly increased in piperine pretreated group compared to LPC and control groups (P<0. 001). Total antioxidant capacity of tissue in piperine pretreated group was more than that in the LPC group and controls (P<0. 0001). Conclusion: Piperine improved spatial memory impairment induced by hippocampal demyelination through enhancing antioxidant defense and myelin repair.

Background and purpose: Vipera lebetina lives in different areas in Iran, and its venom contains a variety of proteins with coagulant and anticoagulant activities. Fibrinolytic enzymes could have a therapeutic role in dissolution of blood clots, so, this study aimed at separating the venom components of Iranian V. lebetina and detecting its anticoagulant activity. Materials and methods: In this experimental study, crude venom components were isolated by gel filtration chromatography on sephadex G-100. We investigated the endopeptidase, arginine ester hydrolase, coagulant, anticoagulant, and fibrinolytic activities in crude venom and separated fractions. Results: The crude venom was separated into five fractions (PI-PV). 200 mg of crude venom contained 187 mg protein and 11. 75 mg protein was recovered from 187 mg protein used on the column. The venom showed coagulant activity at low concentrations and anticoagulant activity at high concentrations. Endopeptidase activity was detected in crude venom and all fractions except PV. Also, arginine ester hydrolase activity was seen in crude venom, PI, and PII. Fibrinolytic activity was found in crude venom and only in PIII. Conclusion: According to this study, the venom of Iranian V. lebetina has strong proteolytic activities including fibrinolytic that dissolve blood clots by lysis fibrin directly in laboratory conditions.

Background and purpose: Ferula persica is traditionally used in treatment of diabetes and rheumatism. There is no report on antioxidant activity of this plant. This investigation was designed to study the impact of extraction methods and solvent polarity on phenolic contents and antioxidant activities of F. persica root and aerial parts. Materials and methods: In this experimental research, the plant was extracted by three methods. Also, it was extracted successively with solvents of different polarities. Antioxidative capacities of the extracts were assessed by three methods. Total phenolic and flavonoid contents were also determined. Results: The highest yield of extraction was achieved by soxhlet assisted extraction. In DPPH radical scavenging activity, the soxhlet extract of aerial parts showed a higher activity which was significantly different from other extracts (IC50= 279. 3 ± 9. 0 μ g ml-1, P<0. 0001). Methanol extract of aerial parts exhibited the highest antioxidant capacity (P<0. 0012). In reducing power assay, compared to other extracts, root ultrasonic and soxhlet assisted extractions showed the highest antioxidative activities (P<0. 0044). Methanolic aerial parts showed the highest activity. The extracts did not show high activities in nitric oxide radical scavenging activity. IC50 for aerial parts ultrasonic extract was 159. 7 μ g/ml and the IC50 for ethyl acetate extract of aerial parts was 441. 2 μ g/ml which showed significantly higher activity compared to other extracts (P<0. 0001). Conclusion: In this study, the extraction methods significantly influenced antioxidant capacities and total phenolic content. Ethyl acetate and n-butanol were found to be more suitable for extraction of phenolics. Maceration is believed to be a more efficient method for extraction of phenolics.

Background and purpose: Dysmenorrhea is associated with one or more systemic symptoms, including nausea and vomiting, fatigue, diarrhea, low back pain, and headache in more than 50% of the cases. These symptoms disrupt social communication in affected women. This investigation was conducted to compare the effect of rosemary and mefenamic acid oral capsules on the symptoms of primary dysmenorrhea. Materials and methods: This randomized double-blind trial was conducted in 82 students with primary dysmenorrhea in Islamic Azad University of Mashhad, Iran. Participants were studied in two cycles for the symptoms of dysmenorrhea. They were randomly assigned into two groups; rosemary (n=45) and mefenamic acid (n=45) using PASS software. They received 250 mg of medications in the first three menstruation days 8-hourly. The visual analogue scale was used to determine the severity of pain. Data were analyzed in SPSS V24. Results: The mean scores for pain intensity significantly reduced in rosemary group and mefenamic acid group compared to baseline scores (16. 81± 10. 96 and 18. 45± 12. 80, respectively) (P<0. 001). But, there were no significant differences between the two groups (P>0. 05). Some symptoms, including nausea in first cycle (P=0. 01) and second cycle (P=0. 02) and boredom in first cycle (P=0. 02) and second cycle (P=0. 01) were found to be significantly different between the two groups. But, other symptoms were not significantly different between the two groups (P>0. 05). Conclusion: Pain reducing effects of rosemary were similar to those of mefenamic acid and it also reduced boredom and nausea. Medicinal drugs cause fewer side effects, therefore, rosemary could be used as an alternative to mefenamic acid in management of dysmenorrhea.

Background and purpose: Hemodialysis is a common treatment for end-stage renal failure, and cannulation causes considerable pain. Topical lidocaine gel and aromatherapy as a complementary medicine are used to relieve the pain. Aromatherapy is associated with fewer side effects than medication, so, the present study was conducted to compare the effect of aromatherapy with Salvia officinalis and topical lidocaine gel on pain intensity during insertion of vascular needles in patients undergoing hemodialysis. Materials and methods: A clinical trial with before and after study design was conducted. Sampling was done using convenience sampling and 23 patients were selected and studied at three stages: pre-intervention, intervention I (topical lidocaine gel 2%, 2 mll or 2 gr in an area of 5 cm2 over the fistula), and intervention II (aromatherapy with 3 drops of leaf extract of S. officinalis 10%). Pain intensity was measured by visual analogue scale and data were analyzed in SPSS V 14. 5 applying repeated measures ANOVA. Results: Mean scores for pain intensity were 6. 09± 1. 28, 4. 30± 2. 36, 4. 13± 1. 98 at preintervention, intervention I, and intervention II phases, respectively. LSD Post-Hoc test showed significant differences in mean scores for pain intensity between pre-intervention and the two intervention phases (P<0. 001), while these phases were not found to be significantly different in mean scores for pain intensity (P=0. 7). Conclusion: According to this study, the aroma of S. officinalis could be used in reducing pain before insertion of vascular needles in patients undergoing hemodialysis.

Background and purpose: Thalassemia is a chronic hereditary anemia that affects patients throughout life due to therapeutic measures such as blood transfusion. The aim of this study was to determine the effect of smartphone games on anxiety, depression, and fatigue in thalassemia patients. Materials and methods: In a quasi-experimental study, 36 thalassemia patients were selected by simple random sampling based on inclusion criteria in Zabol, Iran 2019. They were divided into intervention and control groups. The intervention group were exposed to game therapy using smartphones, during blood transfusion sessions for 21 to 28 days. Levels of anxiety, depression, and fatigue were measured after one month. Data analysis was done in SPSS V22. Results: In intervention group, the mean scores for anxiety (47. 88 ± 5. 89), depression (46. 77 ± 4. 73), and fatigue (61. 33 ± 6. 73) significantly changed after the intervention (37. 66± 6. 12, 37. 61± 6. 13, and 47. 33± 9. 34, respectively) (P≤ 0. 001), while, these values in control group did not show significant changes after the study (47. 38 ± 9. 41 vs. 47. 00 ± 8. 16, 46. 83 ± 8. 55 vs. 44. 88 ± 5. 55, and 59. 61 ± 14. 28 vs. 57. 05 ± 9. 81, respectively). Conclusion: This study confirmed the positive effects of digital games on anxiety, depression, and fatigue in thalassemia patients and suggests this method as a non-pharmacological approach to reduce their problems.

Background and purpose: Supracondylar fracture of the humerus is common in children and various surgical procedures are used to manage this condition. This study was conducted to compare the treatment results of open surgical approaches; external (lateral) and posterior access. Materials and methods: This cross-sectional study was performed in 200 children (younger than 10 years of age) with supracondylar fractures of the arm attending Babol Shahid Beheshti Hospital (2014-2018) who underwent open surgery using either lateral or posterior approach. Radiographic examination and some factors such as age, sex, cause of fracture, type of fracture, fracture side, and range of motion of elbow joint were compared between the two groups at week eight after the surgeries. Results: Among the patients, 98 (48. 8%) underwent surgery with lateral approach and 102 (51. 2%) underwent posterior approach. There were no significant differences between the two groups in age, sex, fracture side, and the predominance of the involved arm (P<0. 05). We observed no significant differences between the range of motion, bearing angle, flexion and extension of the injured side. Clinical and radiological variables in injured and healthy hands in the external approach showed that range of motion (152. 45± 3. 27 vs. 143. 61± 4. 50), carrying angle (11. 98± 1. 72 vs. 11. 44± 2. 75), and flexion (141. 91± 3. 30 vs. 134. 35± 4. 85) and extension (10. 60± 1. 69 vs. 9± 2. 35) of the elbow were lower in the injured hand (P<0. 001). In comparing the clinical and radiological variables between the injured and healthy hand in the posterior approach, it was found that the range of motion (152. 78± 3. 64 vs. 144. 39± 4. 39), carrying angle (12. 4± 1. 47 vs. 11. 62± 1. 83), and flexion (142. 54± 3. 33 vs. 135. 41± 4. 36) and extension (10. 14± 1. 81 vs. 8. 89± 2. 07) of the elbow were lower in the injured hand (P<0. 001). Conclusion: The study showed no significant differences between external and posterior approaches in treatment of supracondylar fractures of the arm.

Background and purpose: Identifying the predictors of seizure recurrence is of great help in controlling the disease and preventing recurrence in patients. This study aimed to determine the risk factors for recurrence of seizures in children younger than 14 years of age. Materials and methods: In this cross-sectional analysis, we reviewed the medical records of patients admitted to pediatric neurology clinic in Tehran Imam Hussein Hospital between June 2016 and November 2017. Information including patients’ demographic and clinical data, and seizure recurrence and times were extracted. Data were analyzed in SPSS V23. Results: The participants were 210 patients (mean age: 62. 40± 46. 79 months), including 53% males. Recurrence of seizures was observed in 81 patients. In 45 patients with recurrent seizures and 101 patients without recurrent seizure, the type of seizure was tonic-clonic. Abnormal developments were seen in 45. 7% of patients with recurrent seizures and 15. 5% of patients without recurrent seizures. Gestational age and abnormality in first electroencephalogram (EEG) were identified as predictors of seizure recurrence. Conclusion: Preventive treatments are highly recommended in patients with low gestational age and disordered EEG to prevent subsequent seizures and their complications.

Background and purpose: The prevalence of antibiotic resistance in Acinetobacter baumannii is increasing worldwide, causing significant clinical problems. This study aimed to determine the antibiotic resistance pattern of clinical A. baumannii isolated from different different wards in Sari hospitals. Materials and methods: This study was performed on 100 clinical A. baumannii isolated from Sari hospitals, north of Iran, 2018. The clinical isolates were identified by biochemical tests, while identification of the blaOXA-51 gene was performed by PCR for the final confirmation of the isolates. Antibiotic susceptibility pattern of the isolates was determined by the disk agar diffusion method. Data were analyzed in SPSS applying Chi-square test. Results: Among 100 clinical isolates of A. baumannii, the lowest resistance rate (75%) was detected against imipenem, while the highest resistance rate (100%) was observed against ciprofloxacin. Resistance rates to meropenem, doripenem, levofloxacin, cefotaxime, ceftazidime, cefepime, piperacillin, piperacillin/ tazobactam, and trimethoprim/sulfamethoxazole were 97, 96, 93, 93, 76, 92, 86, 78, and 92%, respectively. In this study, the highest and lowest cases of MDR and XDR isolates were found in urine and blood samples, respectively, while the highest and lowest cases of MDR and XDR in terms of hospital departments were found in ICU and surgery, respectively. Conclusion: Due to the high prevalence of multidrug resistant isolates, using antibiogram prior to antibiotic administration and proper use of antibiotics for the treatment of infections caused by Acinetobacter baumannii should be seriously considered.

Background and purpose: This study aimed at evaluating utilization of imipenem and assessing the role of pharmacist in rational use of antibiotics. Materials and methods: A retrospective/prospective observational study was conducted in Ramsar Imam Sajjad Hospital in 59 patients receiving imipenem, 2018-2019. In retrospective phase, patients’ records were reviewed, while in prospective phase, a pharmacist provided recommendations on use of imipenem. Duration of taking imipenem, dosage, and dosage adjustment in renal insufficiency were compared with standard protocols. Results: Mean age of the patients was 69. 89± 16. 12 years and there were 29 males. The most common reason for prescribing imipenem was lower respiratory tract infection (54%) which was more used in internal medicine ward (67. 28%) ordered by infectious diseases specialist (65%). In retrospective and prospective phases, mean dosage of imipenem, duration of receiving the antibiotic, and dosage adjustment in renal insufficiency were according to standard protocols in 65% and 85%, 45% and 65%, and 60% and 90% of the cases, respectively (P<0. 001). Conclusion: The role of pharmacist in drug utilization evaluations is of great importance for optimal use of drugs and reducing mortality rates caused by infectious diseases.

Background and purpose: Respiratory function of patients is a major part of orthodontic diagnosis and treatment planning. It is affected by the dimensions of the pharyngeal airway. In this study, these dimensions were compared in patients with different skeletal patterns. Materials and methods: This cross-sectional descriptive-analytical study was performed studying the cephalograms of patients attending the Orthodontic Clinic affiliated with Mazandaran University of Medical Sciences 2016-17. After tracing, 144 cephalograms were divided into three groups: class I, II, and III (n= 48 per group) based on the ANB angle. The nasopharyngeal, oropharyngeal, and hypopharyngeal dimensions were measured. Data were analyzed using SPSS V24. Results: The highest mean dimensions amongst nasopharyngeal, oropharyngeal, and hypopharyngeal spaces were found in class I (21. 25mm), III (10. 49mm), and III (15. 89mm), respectively. There was no significant difference between class I and II in the nasopharyngeal space (P=0. 108). There were significant differences in the mean dimensions of all three spaces studied between class I and III and class II and III (P <0. 05). Conclusion: Airway dimensions seem to vary among different classes of sagittal malocclusion. The dimensions of oropharyngeal and hypopharyngeal airways decrease with increase in ANB angle, but the dimensions of the nasopharyngeal airway are not associated with the changes in ANB angle and are higher in people with class I skeletal occlusion.

Background and purpose: Educating capable, committed and responsive graduates to the needs of patients and the health system can be considered as the most important mission of medical universities in the country. The aim of this study was to examine the role of leading professors and responsive education on development of Third Generation University in order to present a model in Mazandaran University of Medical Sciences. Materials and methods: An applied descriptive study was performed and research population included university directors and faculty members (n=465). Based on Cochran formula, 242 people were selected by random sampling. Data were collected using two researcher made questionnaires; Leading Professors and Responsive Teaching, and the University Entrepreneurial Scorecard Gibb (2012). The validity of the instruments was confirmed and their reliability was calculated using Cronbach's alpha (0. 94, 0. 85 and, 0. 91, respectively). Structural equation modeling was used for data analysis. Results: The roles of leading professors (P= 0. 0001) and responsive teaching (P= 0. 0001) on Third Generation University development were significantly positive and leading professors with a standard coefficient of 0. 462 were found to have greater impact on Third Generation University development. The proposed model also demonstrated a good fit. Conclusion: This research can provide a new perspective for changing the overall policies of university administrators to review faculty empowerment programs.

Background and purpose: Social support is an important feature that can play a major role in creating, maintaining, and promoting health in addition to neutralizing and influencing stressors. Therefore, social factors affecting health are of great importance. This study aimed at investigating the correlation between social support and lifestyle components in patients with myocardial infarction. Materials and methods: We performed a descriptive/analytical cross-sectional study in patients (n=176) with myocardial infarction in 2019. Patients were selected by purposive and convenience sampling. The Health Promoting Lifestyle Profile-II (HPLP-II) and Social Support Appraisals Scale (SSA) were administered and data were collected via direct interviews and patients’ records. Results: The mean scores for social support and lifestyle were 18. 32 ± 0. 31 and 147. 47 ± 7. 01, respectively. The study showed that social support was significantly associated with physical activity (r = 0. 31, P <0. 001), spiritual growth (r = 0. 29, P <0. 001), and impersonal communication (r = 0. 26, P <0. 001). Conclusion: Social support especially in patients with heart disease can affect interpersonal communication, spiritual growth, and physical activity. So, families, friends, and health care providers should support patients as much as possible.

Background and purpose: Acute scrotum syndrome is one of the complaints in emergency departments which has several causes. This study was performed to determine the causes and symptoms of acute scrotal pain in patients attending emergency departments in Mazandaran province, Iran. Materials and methods: A cross-sectional study was done in all patients with acute scrotum syndrome in emergency departments affiliated to Mazandaran University of Medical Sciences, 2011-2016. Patients’ medical records (clinical and paraclinical information, and diagnostic and therapeutic procedures) were investigated. Data analysis was done applying Chi-square test and t-test. Results: The study included 205 patients with a mean age of 34. 10± 17. 34. Patients were diagnosed with testicular torsion (n=60, 29. 3%), epididymo-orchitis (n= 63, 30. 7%), inguinal hernia (n= 69, 33. 7%), varicocele (n=11, 5. 4%), and testicular torsion (n=2, 2. 1%). In testicular torsion, the pain was most sudden (23. 9%) and the duration of symptoms onset and arrival at emergency department was 3. 62± 4. 38 hours. The definitive diagnoses were consistent with ultrasound findings in 91. 7% of the cases with testicular torsion, 96. 8% of those with epididymis orchitis, 95. 7% of patients with hernia, and in 54. 5% of cases with varicocele. Conclusion: Younger age, duration of pain, sudden pain, and cremaster reflex are helpful in differentiating testicular torsion from other causes of acute scrotum syndrome. Ultrasonography of the testis should be immediately performed as the main diagnostic measure for acute scrotum syndrome.

Background and purpose: Learning difficulty in mathematics is one of the most common problems in students. The purpose of this study was to investigate the effect of maternal stress management skills training on improvement of problem-solving skills in students with dyscalculia. Materials and methods: A quasi-experimental study with pre-test post-test control group design was carried out in 30 elementary level school girls (grades 3 and 4) with disabilities in learning mathematics in Qaemshahr, north of Iran. Schools and classes were selected using cluster sampling. The students were selected based on interviews and were randomly assigned into control group or experimental group (n=15 per group). Data were collected using DSM-IV-TR diagnostic checklist, the KeyMath Diagnostic Assessment, the Raven's Progressive Matrices, and General Health Questionnaire-28 (GHQ-28). Both groups received metacognitive training on problem-solving (14 sessions/ 5 weeks). Meanwhile, mothers of students in experimental group attended a training course on stress management (8 sessions/ 4 weeks). Data analysis was done in SPSS V19 applying univariate analysis of variance and P values of less than 0. 01 were regarded as astatisctically significant. Results: Students in both groups showed improvements in problem-solving skills but in experimental group whose mothers received stress management skills training, the students were found with significant improvements compared to the control group (P<0. 001). Conclusion: According to current study, maternal stress management training has considerable effects on improving problem-solving skills in students.

Background and purpose: Contamination of swimming beaches in north of Iran has caused environmental problems in recent years. Mahmoudabad is exposed to these dangers due to having the longest coastline in the country. The aim of this study was to determine microbial water quality of swimming beaches in Mahmoudabad. Materials and methods: In a descriptive-analytical study, we analyzed microbial water quality from 15 different sites in 2019 (monthly). Microbial tests were carried out according to the standard methods for Coliform group and Enterococcus faecalis. Data analysis was performed in SPSS software. Results: The average total coliforms in all sampling sites exceeded 1000 MPN/100 ml in summer, autumn and winter. In all seasons, E. faecalis were detected at highest levels in most of the swimming sites. Other sites had standard fecal coliform microbial quality for swimming beaches. Conclusion: Microbial quality of natural swimming beaches in Mahmudabad was not favorable which could pose health risks to swimmers and travelers.

Dental anomaly in number, size, and shape might occur during dental bud morphodifferentiation stage. Gemination and fusion are the most common anomalies. Gemination exhibits two joined crowns and usually a single root. This case report presents a geminated maxillary lateral incisor in a 15-year-old female admitted with symptoms of irreversible pulpitis and normal apical tissues. Clinical examination revealed deep palatal caries and the patient had no swelling and fistula. Responses to both percussion and palpation were normal. After root canal treatment, the patient did not present any signs and symptoms.

Background and purpose: Prevalence of risk factors for health is growing rapidly in developing countries due to urbanization. In fact much of the global burden of some conditions such as ischemic heart disease is currently in low-and middle-income countries. Therefore, an integrated and effective clinical guide is highly needed for management of patients with stable angina. Materials and methods: Databases and web-related documents were searched in order to extract clinical guidelines on stable angina. After assessing the quality of guidelines, three were selected based on the Appraisal of Guidelines for Research and Evaluation (AGREE) Instrument. Then, a national guideline was compiled along with evidence and recommendations by the panel of experts. Results: Findings were presented in the form of clinical recommendations. For example, acupuncture should not be used in improving or reducing the symptoms of cardiovascular disorders in patients with stable ischemic heart disease. Conclusion: Considering 92 recommendations in this guideline and its adaptation in the Iranian population, this clinical guidline and its recommendations can be effective in standardizing services, screening, referral, diagnosis, treatment, and follow-up of patients with stable angina.

There are evidences on the efficacy of several venotonics in improving postoperative symptoms, including bleeding, pain, etc. A thorough search was conducted in Google Scholar, PubMed, and Cochrane Library covering the articles published in 2000– 2020. We included trials assessing the efficacy of phlebotonics in patients with chronic venous insufficiency and other venous diseases or traumas. Findings suggest superiority of phlebotonic agents over placebo and control treatments in management of common symptoms after phlebectomies, coronary bypass grafting, and other interventions. Significant alleviation of post-procedural symptoms, including pain severity were reported in the majority of patients treated with venotonics. There were no adverse reactions associated with administration of phlebotonic drugs. Nonetheless, further high-quality trials are necessary to support this conclusion.

Breast cancer is considered as one of the main causes of cancer death in women. Early diagnosis and treatment, especially by modern technologies play major roles in management of breast cancer. Radiation therapy is known as one of the main treatment options for breast cancer. Nowadays, 3D printing technology is also used to rapidly construct objects with high quality. Many studies have shown the positive effects of this technology on the results of cancer radiation therapy. The aim of this study was to review the application of 3D printing technology in treatment of breast cancer by mega voltage electron and photon beams, including bolus, applicators, immobilizer devices, and compensators. Creating personalized treatment devices by 3D printing technology reduces treatment errors, therefore, the prescribed dose is increased in the treatment area and subsequently improves treatment outcomes. In spite of the valuable benefits of this technology, there are some disadvantages such as size limitations and the number of materials used for printing. Indeed, recent studies are trying to fix the shortcomings of 3D printing technologies in clinical applications.