JOURNAL OF MAZANDARAN UNIVERSITY OF MEDICAL SCIENCES
Year:2018 | Volume:28 | Issue:163 |Papers Count:24

Background and purpose: Copper is a trace element that is used in various industries. Copper nano-particles are being used in different skin care products، lubricants، oils، polymers، metal covers، plastics، inks، etc. Previous studies have shown that both copper sulfate and copper nano-particles can induce cellular genotoxicity and DNA damage. So، this study aimed at evaluating and comparing genotoxicity in copper nanoparticles and copper sulphate. Assessment of oxidative stress as a mechanism of toxicity was also done. Materials and methods: In this experimental study، blood samples were taken from healthy donors and lymphocytes were separated. Then، lymphocytes were divided into ten groups including control، cisplatin (12µ M)، different concentrations of copper sulphate (10، 25، 50، 100 nM)، and copper nano-particles (10، 25، 50، 100 nM). After 24 h incubation، genotoxicity was investigated by micronucleus and also oxidative stress markers including lipid peroxidation and glutathione. Results: Incubation of blood samples with copper sulfate and nano oxide copper increased the number of micronucleus in lymphocyte. In similar concentration، this increase was higher in nanoparticles group compared with that of the copper sulphate. Also، in both groups receiving copper sulfate and nano oxide copper، lipid peroxidation marker (MDA) and glutathione oxidation increased significantly (p<0. 05). Conclusion: The genotoxicity of copper nanoparticles was found to be higher than that of the copper sulphate. Also، oxidative stress plays a role in genotoxicity of copper sulphate and nano-particles.

Background and purpose: This study aimed at examining the interaction between macronutrients، some micronutrients (magnesium، zinc، iron، calcium، and copper) and CCND2 rs11063069، ZNT8 rs13266634، and MC4R rs12970134 polymorphisms in relation to metabolic syndrome (MetS) and its components. Materials and methods: In this matched nested case-control study، the data for 1634 (817 pairs) case (the new cases of metabolic syndrome) and controls (healthy individuals without metabolic syndrome) were obtained from the Tehran Lipid and Glucose Study. The participants were matched on age، sex، and follow-up years. Dietary intakes were assessed using the Food Frequency Questionnaire (FFQ). The polymorphisms were genotyped by ARMS-PCR. Results: Saturated fatty acid and omega-3 fatty acid could modulate the association of MC4R and ZNT8 variant with MetS، respectively (Pi<0. 05). There was a significant interaction between MC4R rs12970134 with total fat intake and abdominal obesity (Pi=0. 01). Also، significant interaction was observed between rs13266634 with omega 3 fatty acid and poly-unsaturated fatty acid on the risk of dyslipidemia (high TG and low HDL-C) and high fasting blood glucose، respectively (Pi<0. 05). Among micronutrients examined in this study، iron and zinc modified the association of MC4R and ZNT8 variant with abdominal obesity and high fasting blood glucose، respectively (Pi<0. 05). Conclusion: According to our findings، low fat diets are recommended in A allele carriers of MC4R rs12970134، while a diet rich in omega-3 and zinc is more appropriate for C allele carriers of ZNT8 rs13266634.

Background and purpose: Cardiovascular diseases are the leading cause of death in Iran and today these diseases occur at younger ages. The purpose of this study was to assess the effect of educational-based health promotion interventions using the Transtheoretical Model (TTM) on nutritional behaviors (consumption of fruits، vegetables، and fish) in order to reduce the risk factors for cardiovascular disease in high-risk adults. Materials and methods: We conducted a randomized controlled trial in 1230 people aged 30-50 years. Some information including the knowledge، food intake status (fruits، vegetables and fish consumption) and intermediate risk factors such as body mass index، abdominal obesity، blood pressure، blood lipids and blood glucose were recorded. Then 332 high risk participants (intervention group= 164 and control group= 168) were selected via multistage sampling. The interventions was carried out through training classes، brochures and posters، and text messages. Intervention programs were based on individuals’ readiness for behavioral changes. Results: Significant differences were found between the intervention and control groups in knowledge and consumption of fruits and vegetables (p<0. 001). But after the intervention، consumption of fish was not significantly different between the two groups (p= 0. 4). There were significant differences in TTM constructs except self-efficacy (p= 0. 2). Moreover، there were significant differences in biochemical factors except LDL and anthropometric indexes (p= 0. 2). Conclusion: According to this study، the model-based intervention was found effective in increasing health-oriented behavior. Increasing the intake of fish requires broader interventions and changes in anthropometric indexes and LDL demands more time.

Background and purpose: Urinary tract infections (UTI) are one of the most commoncomplications of diabetes. Asymptomatic bacteriuria or frequent symptomatic urinary tract infection arecommon in diabetic patients. Study of bacterial factors of UTI in these patients and the antibioticresistance pattern and resistant strains are necessary. Materials and methods: In this descriptive cross-sectional study, 302 urine samples of diabeticpatients attending Sari diabetes clinic (in 2015) were used. The specimens were cultured in Blood agarand McConkey and incubated at 37° C for 24 hours. Biochemical tests were done to identify thepathogenic bacteria and antibiotic susceptibility test was carried out by Kirby-Bauer disk diffusion. Results: Among the samples, 22. 5% were positive for urinary tract infections including 76. 4%of the females’ samples and 32. 6% of males’ samples. The most prevalent bacteria isolated weregroup B Streptococcus (25%). According to antibiogram testing, the most sensitive antibiotic waschloramphenicol (70%) while cefotaxime, ceftazidime, and ciprofloxacin were found to be highlyresistant. Conclusion: The study showed that the third generations of cephalosporins commonly used intreatment of UTI are not appropriate in diabetic patients. So, Chloramphenicol is recommended fortreatment of these patients.

Background and purpose: Prevalence of antibiotic resistant Staphylococcus aureus strains infoodstuff is becoming a serious health problem, especially in developing countries. This research wasconducted to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) intraditional cheese samples in Mazandaran province, Iran. Materials and methods: In this descriptive cross-sectional study, the presence of MRSA wasinvestigated using specific mecA primers by PCR in 360 cheese samples in Mazandaran province, whichwere collected during one year. The resistance of isolates to vancomycin, erythromycin, oxacillin, ciprofloxacin, penicillin, tetracycline, gentamycin, and cotrimoxazol was determined through discdiffusion method. Results: Among the samples tested, 62. 2% were contaminated by S. aureus (average count of3. 96 log cfu g-1). From 224 isolates 199 (88. 8%) were methicillin-resistant. MRSA resistance toantibiotics was as follows: gentamycin 77%, cotrimoxazol 75%, vancomycin 68%, ciprofloxacin 60%, oxacillin 52%, tetracycline 29%, erythromycin 15%, and penicillin 10%. Conclusion: The results showed high levels of contamination to MRSA in traditional cheesesamples. Proper hygienic handling in farms, using pasteurized milk, and providing people with ampleinformation about health guidelines could prevent cross contamination during processing and prevalenceof the bacteria in traditional products.

Background and purpose: Acute kidney failure is one of the major problems around the world. It increases the rate of morbidity and mortality, and also leads to increased hospitalization time and healthcare costs. This study aimed at investigating the prevalence of acute kidney failure following coronaryartery bypass grafting (CABG). Materials and methods: In a descriptive study, 400 medical records of CABG cases inMazandaran Herat Center (2013-2016) were studied using random sampling. Creatinine levels of 24hours before and after the surgery were recorded in a checklist. Data were analyzed in SPSS V20applying Logistic Regression Analysis. Results: The patients studied included 59% males and 41% females. The mean age of patientswas 61± 9. 05 years. The prevalence of acute renal failure was 13. 5% following CABG. Based onunivariate regression, gender (OR = 5. 71, P < 0. 0001), smoking (OR = 3. 497, P = 0. 006), BMI (OR=3. 023, P =0. 034), and BUN level (OR =3. 026, P = 0. 009) were found to be significantly associated withacute renal injury. Conclusion: In this study, age, sex, smoking, BUN levels and BMI were associated with theincidence of acute kidney failure after CABG.

Background and purpose: Treatment time is one of the main issues in myocardial infarction. The aim of this study was to investigate the factors affecting the time to treatment in patients with acutemyocardial infarction in Zanjan hospitals. Materials and methods: A descriptive-correlational study was performed in 200 patients withmyocardial infarction admitted to educational hospitals in Zanjan, Iran, 2016. Demographic data and timeintervals between the pain onset and treatment were collected using a researcher-made questionnaire. Data were analyzed in SPSS V16 applying t-test and linear regression model. Results: Median time between onset of pain and hospital arrival was 330. 68± 411. 55 minutes andDoor to Balloon Time or Door to Needle Time was 75. 15± 181. 64 minutes. The time to treatment was found tohave a significant association with residence in rural areas (P= 0. 04), misinterpretation of symptoms(P= 0. 01), inadequate income (P<0. 001), and not using emergency medical service (P<0. 001). Accordingto linear regression, the main predictor of late arrival was insufficient income of patients (P<0. 001). Conclusion: In this study, pre-hospital delay was seen more than in-hospital delay. Therefore, itwould be valuable to inform individuals at highest risk for late arrival, particularly those > 60 years of age andliving in villages. In fact, this would help such patients to receive appropriate treatments at a significantlyshorter time.

Background and purpose: Influenza is an acute respiratory disease with annual epidemics which can cause life-threatening complications in people with underlying illnesses such as diabetes، hypertension، kidney and respiratory diseases، and obesity. The aim of this study was to evaluate the risk factors and the underlying factors causing Influenza complications. Materials and methods: This descriptive cross-sectional study was performed using the medical records of 459 patients with influenza in Ghaemshahr Razi Hospital between May 2015 and March 2016. Results: The patients were 49. 5% females (n=227) and 50. 5% males (n= 232) whose median age was 43. 6± 18. 5 years (5-89 years of age). The duration of hospitalization varied from 1 to 43 days (SD= 3. 27). The most common findings in chest CT scans were grand glass. Among the patients، 23 (5%) needed special care. The most common underlying illnesses were diabetes and hypertension and the most common complaints were fever and cough، followed by fever and chills. Conclusion: This study showed that influenza is not limited to a specific sex and age، and some underlying factors such as obesity، chronic pulmonary diseases، heart disease، and taking corticosteroids، and the time interval between the onset of symptoms and hospital arrival are amongst the major risk factors for its complications. More attention on these factors could be of great benefit in reducing the complications of Influenza.

Background and purpose: Educational services are highly expensive، so، accurate financial information could be of great benefit for optimized management of training organizations. Activity-based costing (ABC) is of particular importance for authorities. Materials and methods: In this cross-sectional study، the cost of all educational services was evaluated in the faculty of medicine in Mazandaran University of Medical Sciences، Iran 2015، using the ABC method. After identifying activity centers، costing، including direct and indirect costs، and depreciation and construction costs were determined for each activity according to financial documents obtained from the financial office. Results: The total cost for each student was found to be more than 300 million Rial in 2015. Also، the cost of conducting each class per hour and the cost of each unit of the modules were almost 50 million and 800 million Rial، respectively. Conclusion: Current findings confirmed that medical education is expensive which requires recruiting effective educational staff and optimized management of financial resources to overcome the financial burden. The ABC method is an accurate method that could help the authorities to design and implement a reliable educational financial program.

Background and purpose: Professional quality of life is a concept felt by an individual in relation to their jobs. Positive and negative aspects of a job influence professional quality of life. Evaluation of professional quality of life requires reliable scales. The current study aimed at translating (into Persian) and examining the psychometric properties of professional quality of life scale for health care service providers. Materials and methods: This methodological research was conducted in 464 physicians، midwives and nurses working in hospitals of Qazvin province، using convenience sampling. Based on permission from the developer of the scale، it was back translated. Face validity، content validity، and exploratory and confirmatory factor analyses were tested. Test-retest and internal consistency were used to evaluate the reliability of the questionnaire. Results: Confirmatory factor analysis showed that items 1، 4، 15، 17، and 29 did not present significant factor loadings (<0. 3)، therefore، they were discarded. Factor loadings for other items varied from 0. 32 to 0. 69. Goodness of fit measures was as follows: Normed Fit Index (NFI(: 0. 93; Non Normed Fit Index )NNFI(: 0. 95; Goodness of Fit Index )GFI(: 0. 84; Comparative Fit Index (CFI: (0. 95; X2/ Degrees of freedom )X2/df(: 2. 9، and Root Mean Square Error (RMSE(: 0. 07 (P<0. 001). Intra-class reliability of the scale was 0. 96. Also، reliability of the scale was 0. 73 based on internal consistency (Cronbach's alpha). Conclusion: Present study showed that the modified Persian version of Professional Quality of Life Scale (ProQOL) consisting of 25 items could be used as a valid and reliable instrument in assessing professional quality of life in physicians، midwives، and nurses.

Background and purpose: Silver nanoparticles have different biological effects and are used in treatment of burn infections، open and choronic wounds. Materials and methods: In this study، the bacterial strains of Paenibacillus genus were isolated from soil samples in Damghan، Iran and identified using molecular method. After preparing the condition for silver nanoparticles production، the biological production was proved through spectrophotometry، transmission electron microscopy (TEM)، and X-ray diffraction analysis (XRD). Then، wound induction was done on rats’ skin and the healing effect of nanoparticles was investigated in three groups of rats (treatment، control and phenytoin، n=8 per group). At days 3، 7، 14، and 21 after treatments، the wound area was measured in all groups. Afterwards، wound sampling was carried out for histological evaluations. Results: Silver nanoparticles were produced in spherical shapes (40nm) by Paenibacillus genus. The rate of wound healing was faster in treatment group (the coverage texture was completely formed on day 14) compared to that in other groups. Conclusion: The silver nanoparticles produced had healing property effects which could accelerate wound healing.

Background and purpose: The dissolution of a drug has a major role on its bioavailability. Any change in physico-chemical properties can result in changes in drug release، and furthermore in its bioavailability. Evidence suggest that physicochemical properties of medicinal solids depend on the presence of heat and humidity. In order to overcome such changes، it is necessary to determine the storage conditions required for obtaining a desired drug release. Materials and methods: Theophylline tablets were prepared by Direct Compression method using Carbapol 934 and HPMC K15M. After conducting some initial tests، the tablets were subjected to different conditions of temperature and humidity for six months. Theophylline release from different formulations was analyzed. The data were then fitted to Kinetic model. Differential Scanning Calorimetry (DSC) was used to determine the physical stability of tablets and possible adverse interactions between drugs with polymers or other materials. Results: The results of drug release from different formulations showed no significant differences between various times (zero، three، and six months) (P= 0. 207). Also، by studying the Dsc thermogram of different formulations the peak Theophylline was seen at approximately 275° C، and the thermogram did not show any changes. Conclusion: In this study، keeping Theophylline tablets for three and six months in different conditions did not cause significant changes in drug release. Moreover، no change was observed in the physical stability of tablets.

Background and purpose: Preeclampsia is a serious condition in pregnancy. Previous studies have shown that NT-pro BNP level is higher in preeclamptic patients than that in pregnant women with normal blood pressure. Severity of preeclampsia is one of the critical factors in managing patients، so، this study aimed at investigating the relationship between the level of NT-pro BNP and severity of preeclampsia. Materials and methods: In this descriptive study، three groups of pregnant women with normal blood pressure (n= 29)، non-severe preeclampsia (n= 30)، and severe preeclampsia (n=31) were included. Diagnostic criteria and classification of preeclampsia were based on the guideline for hypertension in pregnancy by the American College of Obstetricians and Gynecologists، 2013. The level of NT-pro BNP was measured by ELISA. Data analysis was done applying t-test، fisher test، Kruskal Wallis، and Mann Whitney. Results: The levels of NT-pro BNP were 40± 26، 55± 33، and 74± 37 pg/ml in pregnant women with normal blood pressure، non-severe preeclampsia، and severe preeclampsia، respectively. Significant differences were found between the cases with normal blood pressure and those with severe preeclampsia in the level of NT-pro BNP (P= 0. 003). Conclusion: The level of NT-pro BNP in preeclamptic women was higher than that of the pregnant women with normal blood pressure which was correlated with the severity of preeclampsia too. It seems that the level of NT-pro BNP could be used to differentiate severe preeclampsia from non-severe cases.

Background and purpose: Nausea and vomiting occur in 50-90% of pregnancies. Maternal-fetal attachment plays an important role in accepting maternal identity، the desired outcome of pregnancy، and the growth of child. This research was done to determine the relationship between pregnancy nausea and vomiting with maternal-fetal attachment. Materials and methods: This Cross sectional study was carried out in 432 pregnant women at 13-20 weeks gestational age attending health care centers in Ahwaz، Iran 2016. Data was collected using the Rhodes Index of Nausea، Vomiting and Retching and the Cranley's Maternal-Fetal Attachment Scale. Data analysis was done applying independent t-test and Chi-square test in SPSS 20. Results: In this study، the mean score for maternal-fetal attachment in women with nausea and vomiting was higher (91. 38± 12. 122) than those without nausea (89. 70± 11. 56) which showed no significant difference between the two groups (P= 0. 141). But، there was a significant difference between the two groups in the scores for attributing characteristics to fetus 19. 96± 4. 17 (P=0. 17) and mother's self-sacrifice 20. 33± 2. 75 (P= 0. 38). Conclusion: Nausea and vomiting during pregnancy did not show any significant association with the overall score for maternal-fetal attachment، but the aspects of maternal-fetal attachment indicated a significant association with pregnancy nausea and vomiting. Women who had more pregnancy nausea and vomiting had lower self-sacrifice and higher rate of attributing characteristics to fetus.

Background and purpose: The radiographic imaging repeat rate (RR) in digital and conventional imaging systems is considered as a quality control indicator. RR increases the unnecessary patient and staff dose، prevents the loss of resources and depreciation of systems and increases the time for radiographic services. In this study، digital radiographic RR and its related factors were investigated. Materials and methods: In current study، 1724 radiographic exposures from two referral hospitals in Sari، Iran were investigated (in 2017). The type of radiographic procedure، the number of repetitive images، and the factors leading to repetition were recorded، prospectively. Data were analyzed by descriptive statistics. Results: The mean of RR in the hospitals was 8. 7%. The highest repeat rates were associated with the performance of staff (69. 4%)، mainly caused by the lack of precision in the alignment of the center of digital panel and central x-ray (18. 7%). Other factors responsible for RR were as follows: the X-ray machine and digital panels (10. 4%)، patients (16. 1%)، and others (4. 1%). Conclusion: Continuous training of staff، highly qualified instructors، using sensors in the x-ray collimator angle to compensate the staff errors، fixed positioning of patients، and relaxed atmosphere can significantly reduce the RR.

Background and purpose: Today، the quality of nursing services is faced with many challenges. A review of Iranian studies showed poor quality nursing services. Nursing education increases the level of quality of care، but patients report different scores for quality of care، so، any shortages should be resolved. The aim of this study was to investigate the effect of nursing education on quality of care using meta-analysis. Methods & Materials: The search was performed in Pubmed، Scopus، Cochrane، Magiran، SID، and Cinahl databases and Google scholar search engine using MeSH and non-MeSH keywords. Studies performed in Iran were selected. The heterogeneity index of the studies was determined using Q and I-Squred tests and applying the inverse of the variance of the random effects model to estimate the overall mean difference standard for quality of care، communication، physical، and psychosocial dimensions. Stata ver. 11 was used for data analysis. Results: In this systematic review and meta-analysis، four articles were found to be eligible. The samples in intervention and control groups included 256 individuals (n=128 per group). The mean score for quality of nursing care was 3. 16 (95% CI). Conclusion: This meta-analysis showed that nursing skills training increased the score for nursing care quality in intervention groups.

Cryptococcosis is a serious fungal infection in both huaman and animals caused by members of the Cryptococcus neoformans/ Cryptococcus gattii species complex. The main route of entry is respiratory tract. Meningitis is the most common clinical manifestation of cryptococcosis in immunocompromised patients and considered as one of AIDS defining illnesses. The known natural sources of the fungus are avian (pigeon، chicken، and other birds) excreta، dead plants and trees like Eucalyptus، Pine، and Fig species. Cryptococcus neoformans/ Cryptococcus gattii species complex have well defined virulence factors that help them to survive and multiply in macrophages and monocytes، escape into blood and disseminate throughut the body. Laboratory diagnosis of cryptococcosis is based on direct microscopy examination، fungal isolation، serology and molecular analysis of serum and cerebrospinal fluid. Amphhotercin B combined with other antifungals including 5-flourocytosisne and fluconazole monotherapy are used for treatment of cryptococcosis. Treatment in HIV infected patients consist of three phases including induction، consolidation and maintenance therapy. The preferred therapeutic regimen is combination therapy of antifungal and highly active antiretroviral therapy. In this article، we summarized recent studies on pathogenesis، diagnosis، and treatment of cryptococcosis in HIV infected patients.

Leishmania is a protozoan parasite responsible for significant morbidity and mortality worldwide. Protozoan parasites of the genus leishmania are found as promastigotes in the sandfly vector and asamastigotes in mammalian macrophages. Mechanisms controlling stage-regulated gene expression inthese organisms are poorly understood. Gene regulation in leishmania, like other trypanosomatides, performs in posttranscriptional and posttranslational levels. However, the correlation between mRNAcontent and protein contents is poor in these parasites. The completion of the genome sequence of severalspecies of Leishmania has had a significant effect on the pathogenesis researches of Leishmaniasis. Theprevalence of parasites becoming resistant to anti-leishmania drugs is increasing in several parts of theworld including Iran. As protein is the most important target for drugs in response to a variety of signalsincluding drugs, so, it seems protein profiles in both of the sensitive and resistant leishmania parasitescould greatly promise about the mechanisms of responses to antileishmanial drugs. Also, many studieshave been carried out to determine the factors associated with leishmania infection as well as theirmolecular mechanisms. In such studies, the new proteomics technology has been of great value. In factone of the main objectives of proteomics is to identify and discover the disease-related pathologies andnovel drug targets. In the current review article, proteomics-based studies investigating leishmania spp. are introduced.