JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2018 | Volume:28 | Issue:162 |Papers Count:20

Background and purpose: Omega-3 fatty acids and vitamin E have supportive effects againstcardiovascular diseases due to antioxidant properties, reduced thrombosis, lipid metabolism, andinflammation. The aim of this study was to investigate the effect of these supplements on lipid profiles incardiac patients. Materials and methods: A randomized, double-blind, placebo controlled trial was conductedin 62 male patients with coronary vascular diseases (CVD). Participants were assigned into three studygroups; OE (omega 3 fatty acids [EPA: 720 mg, DHA: 480 mg], n=22) plus vitamin E (400IU), OP(omega3 fatty acids [EPA: 720 mg, DHA: 480 mg], n=20), and PP (edible paraffin, n=20) for eightweeks. General information and 24-hour recall (at the beginning and the end of the study) and physicalactivity levels were recorded and serum lipid profiles were measured at the beginning and end of thestudy. Nutritionist IV was used to analyze dietary data and statistical data were analyzed using ANOVA, paired t-test, and Chi-square. Results: Omega-3 supplementation alone and plus vitamin E supplement, significantly decreasedserum triglyceride levels at the end of the study in all groups. According to ANCOVA, the meandifferences were also significant after removing the effects of confounding variables such as waist to hip(WHR), fat mass, free fat mass, BMI, and hsCRP (P=0. 008 and P=0. 003, respectively). Conclusion: This supplementation without affecting total cholesterol, LDL-C, and HDL-C levelsreduced triglyceride levels compared to those of the control group.

Background and purpose: Evidence show that hemodialysis patients experience high level ofdeath anxiety. Therefore, many therapeutic interventions are suggested to reduce death anxiety. This studyaimed at investigating the effect of illness perception intervention on death anxiety in hemodialysis patients. Materials and methods: A randomized clinical trial was carried out in 120 hemodialysispatients in Qazvin Bu-Ali Sina Hospital within three months (January to March 2016). Participants wererandomly assigned into either an intervention group (illness perception intervention) or a control group(routine care). Demographic characteristics were recorded and the Templar Death Anxiety Scale andIllness Perception Questionnaire Revised (IPQ-R) were administered in both groups. The interventiongroup received illness perception intervention in three sessions for 30 minutes just before the start of eachhemodialysis. Moreover, a booklet a bout self-care was given to patients. Results: There was no significant differences between the two groups in demographic characteristicsexcept in hemodialysis duration (P= 0. 014). The ANCOVA test showed no significant differences in deathanxiety between the intervention group (43. 73 ± 8. 51) and control group (45. 82 ± 8. 07) (F [1, 112] = 3. 12, P= 0. 080]. Conclusion: Illness perception intervention is a non-pharmaceutical and useful method fordecreasing the level of death anxiety in hemodialysis patients, although the reduction in this study was notstatistically significant.

Background and purpose: Solid lipid nanoparticles are in the colloid carriers. The benefits ofthese drug carriers are the controlled release of the drug and the protection of the drug being loaded. Spironolactone is an aldosterone antagonist and androgen receptor. Its oral bioavailability is low due tothe low solubility of this drug and its slow release. Reducing particle size by increasing the level of thedrug leads to increased release, higher oral bioavailability, higher particle size in contact with thedissolution medium, and increasing the dissolvability of the drug saturation. Materials and methods: Solvent emulsification/evaporation was used to preparespironolactone nanoparticles. For this purpose, the lipid and drug were dissolved in an appropriateorganic solvent and added to the aqueous phase containing surfactant during mixing by homogenizer. After coated with chitosan, the chitosan was dissolved in dilute acid and was added to the suspension onthe stirrer drop by drop. Results: By maintaining the amount of lipid in the formulation and increasing the amount ofsurfactant, the particle size decreased significantly. In general, the coating of spironolactone nanoparticleswith chitosan increased the particle size and their dispersion, and the zeta potential changed from anegative value to a positive value. Conclusion: Spironolactone coated with chitosan was found to have a slower release than solidlipid nanoparticles and nanosuspension.

Background and purpose: This study investigated the effect of different HLBs on thesenanoparticles using spironolactone solid lipid nanoparticles. Materials and methods: The spironolactone loaded SLN was prepared by emulsion/solventevaporation technique followed by ultrasonication. In this study, Palmitic acid was used as carrier. Different weight ratio of drug, carrier, Span60 and Tween80 were selected. Different formulations wereprepared with different HLBs. Nanoparticle properties like particle size, polydispersity index, zetapotential and entrapment efficiency were investigated. Optimum formulation was chosen for evaluation ofdrug release and other properties of nanoparticles by DSC and FT-IR spectroscopy. Results: Increasing lipid concentration resulted in consequent increase entrapment efficiency andthe size. Also, the F1-F9 formulations showed that Zeta potential was in an acceptable range, and onlyreduce in HLB in F4 was accompanied with decreasing Zeta potential. Spironolactone was found to havea higher drug release rate in the SLN form. Information from the FT-IR spectroscopy and the DSCthermogram indicated effective entrapment of drug in the carrier. Conclusion: spironolactone-SLNs provide a controlled and increased drug release rates. Spironolacton-SLN would provide high drug levels at the site of action, therefore, this product could beuseful in topical drug delivery.

Background and purpose: Diabetic foot ulcer is a complication of type 2 diabetes. Variousfactors, such as changes in the level of cytokines (especially IL-1β ) can interfere with the development ofdiabetic foot ulcer. Several factors affect the level of IL-1β levels, including the rate of neurotransmitter, especially dopamine and its receptors. The aim of this study was to investigate the changes in IL-1β anddopamine DRD2 receptor in peripheral blood mononuclear cells (PBMCs) in diabetic foot ulcers. Materials and methods: In a cross sectional comparative study, peripheral blood samples werecollected from 31 subjects with diabetic foot ulcer, 29 without ulcer, and 25 healthy individuals (control). Total mRNA was extracted from PBMCs and cDNA was synthesized to study the DRD2 and il-1β geneexpression variations by real time PCR. Concentration of il-1β was also investigated in sera. Results: Significant decrease was seen in gene expression and sera concentration of il-1β inPBMCs in diabetic patients with foot ulcer. There was also a significant reduction in the expression ofDRD2 receptor gene in patients with and without foot ulcer. Conclusion: Reduction of IL-1β expression seems to be related to changes in the expression ofDRD2 receptor gene. Therefore, after supplementary studies, reducing the expression of DRD2 could beregarded as a prognostic factor and as an effective factor in the spread of diabetic foot ulcer.

Background and purpose: Hemophilia is a hereditary X-linked disorder. Females are carriersand males have the disorder. Hemophilia A is caused by deficiency in the production of factor VIII. Insome hemophilia patients, inhibitors including IgG1 and IgG4 antibodies are expressed against this factor. These inhibitors interact with factor VIII and suppress its function. The current study aimed atinvestigating the relationship between single nucleotide IGSF2 and TNFα genes polymorphism anddevelopment of inhibitors in patients with hemophilia A. Materials and methods: In this case-control study, 100 patients with hemophilia A wereselected (55 with inhibitor and 45 without inhibitor). Recognition of inhibitor was performed by Bethesdatest. DNA was extracted from whole blood samples. A single-nucleotide polymorphism of IGSF2 andTNFα genes was performed using Tetra ARMS-PCR assay. Results: Hardy-Weinberg equilibrium was investigated in both groups. Comparing the IGSF2and TNF-α genotypes in these groups indicated a significant correlation between single-nucleotidepolymorphism of IGSF2 and development of inhibitors (p= 0. 018, odds ratios for AA and AG genotypeswere 1. 39 and 0. 37, respectively). A significant association was seen between incidence of inhibitors andconsanguineous marriages and viral infection (p<0. 05). Moreover, the association between response totreatment and Bethesda test was significantly different between the two groups (p= 0. 002). Conclusion: According to these results, the risk of development of inhibitors has a directrelationship with mutation in IGSF2 gene.

Background and purpose: Proton pump inhibitors (PPIs) are one of the main therapeuticagents for acid-dependent diseases. Inappropriate use of this group of drugs especially Intravenous formof pantoprazole can lead to unnecessary cost. The aim of this study was to assess the IV Pantoprazoleutilization in a teaching hospital in North of Iran. Materials and methods: This cross sectional study was performed within four months in 100patients hospitalized in Ramsar Imam Sajjad Hospital, 2016. Demographic data, type and doses ofPantoprazole, risk factors for stress ulcer, and other relevant clinical data were recorded. Appropriate useof Pantoprazole was assessed according to recommendations provided by Fact Drug Information 2016, Medscape 2016, and UpToDate 2016. Results: Among the patients 54% had indication for receiving a PPI and only 16% had indicationfor parenteral form of PPI. Oral PPIs could have been used in 73% of the patients but they receivedparenteral form of Pantoprazole. In 92% of IV injections, a vial of 40 mg Pantoprazole was dissolved in10 ml distilled water and injection was done in less than 10 seconds which was incompatible withguidelines. Conclusion: In current study, utilization of Pantoprazole was not compatible with guidelines inmost cases, including right indication, right preparation methods and right rate of drug administration.

Background and purpose: Pregnancy is one of the factors that affect the mental and physicalhealth of women. The aim of this study was to determine mental health in pregnant women and its relatedfactors. Materials and methods: A descriptive cross-sectional study was conducted in 834 pregnantwomen in health centers in Sari, Iran, 2017. The Persian version of Symptoms checklist-90-R was used. Data analysis was done in SPSS V22 using independent T test, One-way ANOVA, and Chi-square. Kruskal– Wallis test was applied in absence of normality assumption. Results: The mean age of participants was 25. 5± 507 years and the mean gestational age was 23weeks. Among the subjects 689 (82. 6%) were healthy, 141 (16. 9%) were found with moderate disordersand 4 (0. 5%) had moderate to severe disorders. Somatization (28. 6%) and hostility (17%) were thehighest and lowest prevalent disorders, respectively. Comparing the mean scores of the nine aspect of theSymptoms checklist-SCL-90-R showed significant differences between different age groups, educationallevel, occupation, gestational age, and problems in previous pregnancies (P<0. 05). Conclusion: Current findings indicated a mild to moderate prevalence of psychiatric disorders inpregnant women. The severity of each mental health disorder was linked to demographic characteristics, gestational age, problems in previous pregnancies, and unwanted pregnancies.

Background and purpose: Self-efficacy as one of the main concepts of social cognitive theorycould play a major role in different dimensions of health behaviors and empowerment of patients withchronic diseases. The aim of this study was to investigate self-efficacy and predict its related factors inpatients with chronic diseases. Materials and methods: This descriptive cross-sectional study was performed in 400 patientswith chronic heart and kidney diseases, diabetes, and high blood pressure in three hospitals affiliated toMazandaran University of Medical Sciences. This study was carried out using a simple random samplingand applying the Chronic Disease Self-efficacy Scale (CDSES). SPSS V23 was used to descriptive andanalytical data applying multiple linear regression. Results: The mean score for self-efficacy was 5. 17 ± 5. 11. Multiple linear regression analysisshowed some variables, including the age (CI95:-1. 400,-0. 573, β =-0. 228, P <0. 001), educational level(CI95: 1. 311, 6. 000, β =0. 149, P= 0. 002), and income level (CI95: 12. 585, 23. 901, β = 0. 319, P<0. 001) asthe predictors of self-efficacy in chronic patients. Conclusion: In this study, the majority of patients with chronic diseases had a moderate level ofself-efficacy. Chronic diseases are highly prevalent today, therefore, more precise planning is needed topromote self-efficacy which is the main factor in improving self-care and health behaviors of patientswith chronic diseases.

Background and purpose: Neurofibromatosis type 1 (NF1) is a dominant genetic disorder ofthe skin and the nervous system that is seen in equal proportions in both sexes. The incidence of NF1 isabout one in every 3, 000. Chronic skin diseases have a significant impact on the individual's mentalimage and also affect mental health and quality of life. The aim of this study was to investigate the qualityof life in a group of Iranian patients with NF1 suffering from skin problems. Materials and methods: A cross-sectional, descriptive-analytical study was conducted in 2015-2017 in 193 patients with NF1 attending the Iranian Neurofibromatosis Society, using convenientsampling. Data were collected by Skindex-16 quality of life measure which is composed of 16 questionsin three dimensions (emotions, symptoms, and performance). Data were analyzed using SPSS applyingPearson Correlation and ANOVA. Results: Of 193 patients with NF1, 69. 5% (n=132) were females. The mean age of patients was31. 58± 9. 21. The mean score for quality of life was 44. 88± 22. 06. In the domains of symptoms, emotions, and performance the mean scores were 6. 57± 4. 99, 24. 76± 11. 64, and 13. 64± 8. 86, respectively. Quality oflife was not statistically correlated with age and sex, but the relationship between the domain ofsymptoms with age was found to be significant (P=0. 01). Conclusion: The results showed that patients with neurofibromatosis have moderate quality oflife and lower quality in terms of emotions and performance. These findings can be used to provide betterhealth care for this group of patients and improve their quality of life.

Background and purpose: In recent years a severe decline occurred in fertility rates in Iran, therefore, policy makers changed demographic policies since 2012 and provided incentives for families. The purpose of this study was to investigate the relationship between fertility motives and attitudestoward government incentives that could promote childbearing in women in fertility ages. Materials and methods: This cross-sectional study was performed in 450 women (18-35 yearsof age) attending health centers in Sabzevar, Iran 2016, using convenience and cluster samplings. Theinclusion criteria were being married and not pregnant at the time of study. Demographic information wasrecorded and data was collected using Childbearing Motivations Scale and the scale for Attitude towardsGovernmental Incentives on Childbearing. Data analysis was done applying descriptive statistics, Pearsoncorrelation tests, Spearman, and Kruskal Wallis test. P value of ≤ 0. 05 was considered to be significant. Results: There was a significant direct correlation between the positive fertility motivation andfree mother and child insurance (P= 0. 004), free monthly check-ups, free pregnant mothers' food coupon(P= 0. 01), and increased maternal leave (P= 0. 01). In current study, a significant reverse correlation wasfound between negative fertility motivation and offering gold (P= 0. 01), home mortgage and loans (P=0. 001), providing home (P= 0. 001), and paternity leave (P= 0. 004). Conclusion: According to this study government incentives on childbearing must focus on majoreffective factors on fertility motivation i. e. free mother and child insurance, offering gold, home mortgageand loans, and providing homes to the families.

Background and purpose: Preterm birth is a stressful situation for parents and the infant, whichmay lead to difficulties in mother-infant relationships and disturb emotional and cognitive development ininfants. The purpose of this study was to investigate the factorial structure, validity, and reliability of theParenting Stress Scale for Mothers of Premature Infants. Materials and methods: The research sample included 500 mothers of premature infantsselected via convenient sampling. They were divided into two groups (n=250 per group). Cronbach'salpha coefficient was used to evaluate the reliability of the scale. Exploration and confirmation factoranalysis were applied to investigate the validity of the scale. Results: The Parenting Stress Scale for Mothers of Premature Infants was found to have anacceptable internal consistency and the Cronbach's alpha coefficient was 0. 918. Test-re test reliabilitycoefficient was 0. 833 after 15 days. Three factors of parenting stress, mother-infant turbulent interaction, and parental expectations were obtained under the varimax rotation. The exploratory and confirmatoryfactor analysis also confirmed that the structure of the scale had an acceptable fit to the data, and allindicators confirmed the fitting goodness of this model. Conclusion: Findings showed that this scale has appropriate psychometric properties whichcould be suitable in evaluating parenting stress for mothers of premature infants.

Background and purpose: One of the solutions for sludge production is to reduce that viadecreasing the yield coefficient by oxic-settling anoxic process with different oxidation reductionpotential (ORP) in sequencing batch reactor (SBR) activated sludge. Materials and methods: We used 2 SBR reactors (20 L volume) that were controlled online. At a steady state in reactors, some parameters such as COD, DO, SVI, ORO, dry solids and moisture ofsludge were tested during 12 months. Finally, yield coefficient and reduction rate of biological excesssludge were studied. Results: At 10-day sludge age, the best removal efficiency of COD (95%) was seen without anysludge bulking problems and the kinetic coefficient Y and Kd were 0. 58        g CODg Biomassand 0. 058   d1, respectively. The anoxic and anaerobic phase of the sludge holding tank showed that sludge storage after7 hours in the reactor with ORP=-238 decreased the yield coefficient from 0. 58 in the control reactor to0. 25g of biomass in g of COD. Consequently, the excess sludge decreased by almost 60%. On the otherhand, compared to the control reactor (92 ml/g), the SVI reduced to less than 40 ml/g. Conclusion: Using holding tanks in aerobic conditions with ORP greater than 230mv couldcause appropriate settling and lead to a high efficiency of COD removal from wastewater.

Background and purpose: Low Back Pain (LBP) is one the major public health problems inthe world. Lifestyle is one of the most important factors affecting the health of employees. The aim of thisstudy was to determine the association between LBP and lifestyle among employees in MazandaranUniversity of Medical Sciences. Materials and methods: In a cross-sectional descriptive analysis, 186 people working inMazandaran University of Medical Sciences, 2017, were recruited. Nordic Musculoskeletal DisordersQuestionnaire (NMQ) and Lifestyle Questionnaire (LSQ) were administered. Data were analyzedapplying Chi square and logistic regression tests. Results: The average age of the staff was 40± 9. 002. Among the participants 54. 7% were males, 47. 8% hold master’ s degree and 45. 9% had LBP. The prevalence of LBP was 54. 5% in females and37. 8% in males. The results showed that physical health, exercise and health, mental health, social health, and gender were associated with incidence of LBP in population studied. Conclusion: In this study, LBP in staff was associated with their gender and lifestyle. So, lifestyle modification could be effective in remission of low back pain.

Background and purpose: Improving patient satisfaction was the main goal of HealthTransformation Plan (HTP) in Iran. This research aimed to study cancer patient satisfaction followingimplementation of HTP in Sari Imam Khomeini Hospital, Iran 2015. Materials and methods: A descriptive cross-sectional study was conducted in 386 cancerpatients using census sampling. Data was collected by administering cancer patient satisfactionquestionnaire and analyzed in SPSS. Results: The respondents reported 70% overall satisfaction. They were more satisfied with thestaff attitude and helpfulness, service value, staff competence, and hospital equipment. On the other hand, they were least satisfied with access to recreational facilities, medicines, comprehensive services, painmanagement and relief, and hospital catering. Patient satisfaction of the HTP was about 64%. About 12, 49. 2 and 38. 8% of the participants were found to be dissatisfied, moderately, and fully satisfied withHTP, respectively. Conclusion: Overall, patients were satisfied with The HTP. However, hospital managers shouldbe trained and empowered to apply quality management strategies to increase patient satisfaction.

Gestational diabetes mellitus (GDM) is the most common metabolic complication of pregnancy. Compared with individuals without diabetes, women with GDM, in absence of intervention, are at higherrisk of adverse maternal and fetal outcomes. The recent and unexpected increase in the prevalence ofGDM and the average results of dietary interventions could partly be due to inattention or failure inmodifying the new composition and inappropriate intestinal micro flora which occurs often in the secondhalf of pregnancy particularly when accompanied by obesity. In the spectrum of lifestyle-related factors, probiotics are proposed as part of a balanced diet, affordable, practical and potentially effective approachto this health problem. The purpose of this narrative review paper was to review previous studiesaccording to the importance of probiotics and their role in prevention and treatment of GDM. Electronicsearch was done in databases, including Scopus, Science direct, PubMed, Cochrane central, GoogleScholar, ISC, Magiran, IranMedex, SID, and MedLib. Evidence suggest that manipulation of microbiotain gut during pregnancy by selected probiotics in women at risk of or affected by GDM, can probably beof great benefit in improving the metabolic profile of mother and pregnancy results.

Background and Aim: Premarital sex is forbidden legally, culturally, and religiously in Iran. Compared to other youth, this behavior is less common among religious youth and theists. This studyaimed at providing a systematic review of the relation between religion and spirituality and premarital sexamong youth in Iran. Materials and Methods: In this systematic review, PubMed, Scopus, PreQuest, GoogleScholar, Magiran, Irandoc, and SID databases were searched for articles published until April 2017 usingsome keywords, including premarital sexual relationship, religion, spiritual, etc. All papers on the relationbetween religious, spirituality, and premarital sex among Iranian youth were investigated. We found 162articles, from which 13 were selected based on the study’ s inclusion criteria. Afterwards, qualitativeanalysis of data was conducted. Results: A total of 8636 youth had been studied in 13 quantitative studies. Many studies hadinvestigated the relationship between religion and premarital sex (53. 85%). Other studies included theassociation between religion and the attitudes towards premarital sex and the desire for that. Conclusion: Compared to other countries, there are few studies on the relation between religionand spirituality and youth sexual behavior in Iran. According to the importance of premarital sexualrelation among Iranian youths, and heterogeneity of information on this subject in previous studies, further researches are required with strong methodologies and more culturally appropriate tools.

Depression is widely reported in patients with physical illness, but its prevalence varies in studiesand differs from one disease to another. In patients with depression, severity of symptoms may bedifferent in various medical conditions and responses to treatment. We aimed to systematically (a)compare the prevalence of depression between medical illness patients and mentally healthy subjects, (b)assess whether there is an independent association between medical illness and depression, (c) identifyassociated factors used in interventions (d) and review the relationship between depression and baselinedisease severity and treatment outcomes. We studied 24 researches that had examined medical illness and depression in Mazandaranprovince, Iran. The prevalence of possible depression in patients with physical illness ranged from 13. 1 to67. 4%, depending on diagnostic methods and sensitivity of various depression scales. Depression wasfound to have a negative influence on the outcomes of physical illness and treatment response. The significant outbreak of mental disorders, especially depression in patients with physicalillness, and the negative impact of mental disorders on the control and treatment of diseases call forregular psychiatric counseling.