Journal of Mazandaran University of Medical Sciences
Year:2011 | Volume:21 | Issue:84|Papers Count:24

Background and purpose: Gastric cancer has been considered as the second lethal cancer throughout the world and the incidence of this cancer in Iran is 25 in 10000 people per year. Interleukin- 11 (IL-11), a member of IL-6 family, may play some role in developing gastric cancer via activation of the JAK/STAT signaling pathway. In this study, the level of IL-11 gene expression was determined in gastric biopsy specimens of patients with and without gastric cancer.Materials and methods: In this case-control study, biopsy specimens were collected from Imam Khomeini Hospital and Tooba Clinic in Sari. Based on the histopathologic and endoscopic assessments, patients were divided into two groups of gastric cancer patients (n=45) and those without gastric cancer (n=45). To determine the level of gene expression of IL-11, SYBR Green Real-time PCR method was employed. The obtained data were analyzed using REST 2008 and SPSS16.Results: The histopathology of the biopsy specimens were determined as intestinal adenocarcinoma (93.4%), diffused adenocarcinoma (4.4%), and carcinoid tumor (2.2%). The level of IL-11 gene expression was significantly higher in gastric cancer samples compared with individuals (p<0.05); moreover, no change in the expression of this gene in patients with other digestive complications without gastric cancer was observed (p=0.81).Conclusion: It is suggested that IL-11 has relationship with developing gastric cancer and it is likely involved in the process of tumorgenesis, proliferation and survival by increasing the anti-apoptotic activity.

Background and purpose: Finding an efficient vaccine against HIV infection is still a major concern and a great challenge. In our previous study, HIV-1 virions with capability of a single replication were produced. In the present study their immunological evaluation has been carried out to study their induction of cellular and humoral responses in mice model.Materials and methods: In this study, first and second virion generations were produced in human HEK293T cells, and were injected to three different mice groups in three doses with or without adjuvants. After the last injection, immune responses were evaluated in serum and spleen cells of mice using ELISA.Results: Although all animals vaccinated with different immunogen regimens did develop cellular responses, in the main group injected with novel adjuvants, the highest levels of specific antibody, IFN-Y, IL-4 an also most IFN-Y excreting cells were evident, which is suggestive of a strong cellular response in these cells.Conclusion: An effective vaccine against HIV requires induction of strong humoral and cellular responses. Hence, these results demonstrate the high immune system stimulating capabilities of virion injection regime accompanied by M720 and CpG adjuvants, which provides the potential for an efficient HIV vaccine.

Background and purpose: Polymerase chain reaction (PCR) is a rather quick and accurate method employed for gene detection and isolation. Primer designing is an important issue in this technique and plays a critical role in considering both the genome properties and cloning of the isolated genes. Streptomycin antibiotic is produced by Streptomyces griseus using str gene cluster with more than 25 genes. This gene cluster contains StrR gene encoding a specific protein regulator of this cluster. The pathway specific transcriptional activator then induces transcription of other genes in the str gene cluster. In this study, the researchers aimed at isolating promoterless StrR2 gene and then cloning it.Materials and methods: To isolate promoterless StrR gene, a set of primers (StrR2) was designed. One pair of these primers (St Nes) detected the StrR from the genome. Moreover, Nested-PCR was then used to detect amplified StrR2 gene. Sites for BamHI and XbaI were designed in other primers (Str nP1and Str nP2). These primers not only amplified the StrR2 gene but also created restriction enzyme sites in the amplified fragments.Results: Using PCR, the promoterless StrR2 gene was amplified and its structure was confirmed. This gene was successfully cloned, too. The correct structure of the recombinant plasmids was confirmed using different techniques such as gel electrophoresis, PCR and restriction digestion analysis.Conclusion: Using this vector, one can subclone the promoterless StrR2 gene in the Streptomyces expression vectors containing inducible promoters.

Background and purpose: Cardiovascular diseases are the most common causes of death in Iran as well as in the world. SDF-1a, as an effective chemokine for decreasing inflammation and injury, plays a role in angiogenesis. This study compares and evaluates serum level of this chemokine in healthy people and those with AMI (Acute Myocardial Infarction) regarding age and gender.Materials and methods: This case-control study was conducted on two groups: 63 patients and 63 healthy participants (the relatives of other patients in other wards). Blood samples were taken in the first 24h of admission in both groups, whereas in the case group another blood sample was taken in the seventh day after admission. Data were collected through taking history of the patients and Paraclinic.Serum level of SDF-1a was also measured in the participants.Results: Among the participants enrolled in each group, 79.4% were males and 20.6% were females. In the AMI group, 80.95% were admitted due to their first heart attack and 63.5% had Q wave MI at the time of discharge. There was no significant difference in the serum concentration of SDF-1a between control (33.58) and case (33.71) groups in the blood sample taken in the first 24 hours (p>0.05). However, a significant difference was observed between that of the first day blood sample taken from the control group and the seventh day sample of the case group (132.12, p<0.05).Conclusion: Our study showed that the concentration of SDF-1a increased during the first week after AMI. Therefore, SDF1-a can be effective in AMI as an anti inflammatory and angiogenetic chemokine.

Background and purpose: Lactoferrin is a multifunctional protein, which is useful for clinical and commercial applications. Recently it has been shown that ingestion of Lactoferrin has advantages including: immune system modulation, anti-microbial activity and antioxidant in neonates and adults in both animals and humans. The present study has been conducted with the purpose of isolation and optimal purification of Lactoferrin from cow’s milk.Materials and methods: Bovine colostrum was collected during 72 hours of delivery. First, milk fat was separated. To Isolate Lactoferrin from the rest of the milk proteins, the isolation process was conducted in two steps. Casein was precipitated using ammonium sulfate and in the next step Lactoferrin was isolated using CM-Sephadex-C50 cation exchange chromatography column with FPLC. To identify the isolated protein SDS-PAGE method was used.Results: The pure active protein, with a molecular weight of 80 kDa, with concentration of 2.4 mg/ml was obtained. The degree of purification implementing after cation exchange chromatography column was 4 and purification efficiency 90%.Conclusion: Considering the increase in the clinical and nutritional applications of Lactoferrin and particularly its immunomodulatory effects, finding an appropriate and efficient purification method is very important. The results of the study show that the above-mentioned method, apart from simplicity and speed, can result in isolation of highly pure Lactoferrin.

Background and purpose: Antioxidant and anti-inflammatory compounds can be effective in the treatment of ulcerative colitis. Silymarin has antioxidant and anti-inflammatory properties. The aim of the present study was to evaluate possible useful effects of Silymarin on the reduction of colonic damage and inflammation in experimental acute colitis induced by intracolonic administration of acetic acid.Materials and methods: Fifty adult Wistar rats were randomly divided into five groups (n=10): control group, colitis group, colitis group treated with 50 mg/kg Silymarin, colitis group treated with 100 mg/kg Silymarin and colitis group treated with 500 mg/kg Sulfasalazine. Experimental colitis was induced with intrarectal administration of 1 ml acetic acid (4%). Rats were fed Sylimarin for 14 days before and 2 days after the induction of colitis. Two days after the induction of colitis the mice were sacrificed and macroscopic and microscopic colon damages were studied.Results: Administration of acetic acid induced severe macroscopic and microscopic damages and inflammation in mucosal tissue. Tissue edema, inflammation, microscopic and macroscopic damages were reduced by Sulfasalazine. Silymarin at both 50 and 100 mg/kg doses reduced macroscopic damages. Silymarin administration at 100 mg/kg ameliorated microscopic damages and tissue inflammation. However, administration of 50 mg/kg Silymarin had no significant effects on crypt damage and inflammation.Conclusion: These results propose that Silymarin could be beneficial in reducing damages caused by ulcerative colitis.

Background and purpose: Although congenital hypothyroidism is a preventable cause of mental disabilities, less than 10% of newborns are diagnosed based on clinical symptoms in the first month. If the diagnosis is not made based on screening programs, it would be delayed and irrepairable cerebral and auditory complications will occur. The purpose of this study was to determine the prevalence of congenital hypothyroidism in the Mazandaran province.Materials and methods: The study is a descriptive (screening) survey. From infants born from January 2007 to January 2008 in Mazandaran province heel blood samples on filter paper were obtained. TSH values were measured by ELISA method and TSH>5 mlu/L was considered as the recall criterion. Diagnosis of neonatal hypothyroidism was made based on TSH>10 and T4<6.5. Treatment was performed based on the results of second tests. Except in cases where the initial TSH was greater or equal to 20 -where the treatment was started from the beginning- if the second test results were reported normal, treatment was discontinued and the case was considered as a transient hypothyroidism.Results: Out of 45218 infants studied, 49% were female and 51% were male.4.6% of newborns (2109) were recalled, among whom 1885 had 5<TSH<10 mlu/L and 185 had 10<TSH<20 mlu/L and 39 had TSH ³20.73 infants were diagnosed with hypothyroidism. Thus, the prevalence of neonatal hypothyroidism was 1.6/1000 in live births in Mazandaran province. Also prevalence of transient neonatal hypothyroidism was 1 in every 2500 live births.Conclusion: Given the high prevalence of hypothyroidism in the province, more screening programs are essential.

Background and purpose: Exposure to respirable particles (PM2.5) causes adverse health effects, such as: respiratory and cardiovascular diseases and eventually death. Considering congested traffic flow in the city center of Sari, it could be expected that exposure of citizens to particulate air pollution would be high. The aim of this study was to survey the concentrations of PM2.5 indoor and outdoor of shops and to determine other factors effective upon concentrations of PM2.5 indoor of shops in city center of Sari.Materials and methods: This study was carried out in and outside of 185 non-source shops that were located on 4 main streets in the central part of the city of Sari. A calibrated real time dust monitor (MicroDust Pro) was used for sampling. Sixty 10-second samples were collected from indoor and outdoor of each shop and relevant information was recorded in a questionnaire.Results: Mean outdoor concentrations of PM2.5 (83.6 mgm-3) were higher than indoor PM2.5 levels (82.2 mgm-3). Concentrations of PM2.5 indoor the shops had a significant correlation with the concentration of these particles outdoor. The mean of concentration of PM2.5 was the highest during the high traffic flows in the morning and evening. A weak but significant correlation was found between indoor concentrations of PM2.5 and other air-pollution-related variablesConclusion: Results showed that the concentration of PM2.5 particles outdoor the shop is the main cause of their accumulation indoor. Concentrations of respirable particles (PM2.5) indoor and outdoor of shops in the city center of Sari were higher than the recommended 24-hour standards.

Background and purpose: The newborn birth weight is an important indicator for prenatal care, general health and fetal viability. The aim of this study was to assess the relationship between prepregnancy BMI and pregnancy weight gain on neonatal birth weight.Materials and methods: In a descriptive-analytical study, 16-40 years old pregnant mothers registered to prenatal clinics of Lowlagar and Mahdieh Hospitals in Tehran in the year 2009 were studied. Simple sampling method was used. Weight gain during prenatal visits was recorded and mothers were followed up for maternal-fetal outcomes till delivery. The association between primary BMI, total pregnancy weight gain and birth weight was assessed by multivariate regression model.Results: 1084 eligible mothers with singleton, low risk pregnancy were studied. There was a statistically significant relationship between pre-pregnancy BMI and pregnancy weight gain and newborn birth weight (p<0.05). In addition, maternal weight gain during pregnancy and neonate birth weight were related (p<0.001). Results of linear regression analysis showed that gestational age at birth, total pregnancy weight gain and pre-pregnancy BMI were effective in prediction of the neonate birth weight, with the gestational age at the time of labor having the highest impact on neonatal weight at birth (p<0.05).Conclusion: Based on the results, pregnancy weight gain regardless of pre-pregnancy BMI affects newborn birth weight. Therefore, appropriate maternal weight gain during pregnancy should be emphasized in support of neonatal health.

Background and purpose: Inadequate and improper prenatal care may result in adverse consequences, including preterm labor. Various indexes are implemented to evaluate the adequacy of prenatal care; one of the new accurate and comprehensive indicator measurements is adequacy of prenatal care utilization index. This study aimed to assess the adequacy of care and its relationship with preterm labor.Materials and methods: This analytic historical cohort study was performed on 420 mothers, referred to health centers in Sari during 2010. Data was collected through interviews and questionnaires, credibility of which was assessed through content validity and its reliability through test re-test. Based on adequacy of prenatal care utilization, this care was classified in four groups: intensive, adequate, moderate and inadequate.Results: The results showed that from a total of 420 mothers studied, 151 mothers (36%) had inadequate care. The rate of preterm labor in mothers receiving inadequate care was RR=1.36 times more than those receiving adequate and intensive care (p<0.05). Based on adequacy of prenatal care index, there was no significant relationship between age, employment, education, body mass index and attendance of childbirth preparation classes (p>0.05). But there was a significant relationship between the first prenatal visit, number of visits, delivery, pregnancy routine tests and number of ultrasounds performed during pregnancy (p<0.05).Conclusion: Considering the program of reducing the number of referrals of pregnant mothers (Standardization Protocol for mothers in Iran), this study, along with confirmation of effect of adequacy of prenatal care on reducing preterm labor, emphasizes on providing the minimum care (based on the national Protocol).

Background and purpose: Both the condition of infertility and its treatment cause stress in couples. IN-Vitro Fertilization (IVF) is a stressful procedure for patients. Evidence has shown that, in addition to biomedical factors (such as age and history of pregnancy), psychological factors are related to the outcome of IVF treatment.Materials and methods: This cohort study was performed in 2008 on 70 (35 patients in case group and 35 patients in control group) candidates for IVF in two infertility clinics in Sari. Psychiatric assessment of patients was done before Gonadotropine injection for IVF by a psychiatrist with standard questionnaires. Anxiety and depression questionnaires were completed by the patients. Based on the results drawn from the questionnaires, the control group was formed from individuals with no anxiety or depression or individuals suffering from mild anxiety and depression or either of them. Individuals of the case group were suffering from moderate to severe anxiety and depression or either of them.Results: Mean age of patients was 30.25±4.63 year in case group and 30.37±4.67 year in control group. Pregnancy rate was 31.42% in case and 54.54% in control group. Relative risk for not becoming pregnant in individuals suffering from moderate to severe anxiety and depression was1.5 and attributable risk was 33%.Conclusion: Pregnancy rate in normal individuals or individuals suffering mild anxiety and depression or either of them, was higher. Than those suffering from moderate to severe depression.

Background and purpose: Severe, tormenting and long-term coughing in patients suffering from pertussis causes disturbances in their and their families’ daily activity. The aim of this study was to evaluate the effect of Tramadol on alleviating coughing and severity of symptoms in pertussis patients.Materials and methods: Sixty cases of adult pertussis patients based on WHO and CDC guidelines were included in the study. Based on the severity of their clinical symptoms, they were divided into moderate and severe groups. The case group received Azithromycine, Cetirizine and Tramadol but the control group received only Azithromycine and Cetirizine.Results: The case group consisted of 13 male (43.33%) and 17 female (56.66%) patients: sixteen cases had severe and 14 cases moderate symptoms. The control group consisted of 14 male (46.66%) and 16 female (53.33%) patients: 17 cases had severe and 13 cases moderate symptoms. After one week of treatment in the case group, 7 cases were severe (22.33%) and 6 cases were moderate (20%) (p<0.05) but in the control group 43.33% were severe and 33.33% were moderate (p<0.05).Conclusion: A faster and more suitable reduction in clinical symptoms, especially coughing, using tramadol with an appropriate dose, can result in an improvement in patients’ quality of life.

Background and purpose: Respiratory disorders and need for mechanical ventilation are common complications in preterm infants. Attention has been drawn to premature weaning from ventilator and also removal of endotracheal tube with an approach towards reduction of risks. This study has been carried out to compare the outcomes of two methods of NIMV and NCPAP in infants afflicted with respiratory distress syndrome under mechanical ventilation.Materials and methods: This study is a randomized clinical study that has been conducted throughout 2009 to 2010. A total of 40 infants in two groups of case and control have been studied. Infants of 28 to 32 and 32 to 37 weeks of age were randomly placed in two NIMV and NCPAP groups and re-intubation, and complications of the two methods were compared in infants.Results: Infants in the two groups were identical regarding gender, gestational age, birth weight, type of delivery, mechanical ventilation period and use of surfactant and steroids prior to delivery. Reintubation, respiratory acidosis and intra-ventricular hemorrhage were less in NIMV group (p<0.05). There was no significant difference in apnea, hypoxia, pneumothorax, feeding intolerance, abdominal distention, length of hospitalization and death rates.Conclusion: The study has shown that respiratory acidosis in NIMV group is less in comparison to NCPAP group. Therefore, in order to prevent re-intubation and occurrence of respiratory acidosis and to reduce occurrence of intra-ventricular hemorrhage in infants suffering from respiratory distress syndrome in time of weaning from mechanical ventilation, it is necessary to use the NIMV method.

Background and purpose: Fear of negative evaluation consists of anxiousness about other people’s evaluation of oneself, worries resulting from these negative evaluations, and the expectations from others, that they would develop only negative evaluations of one. The purpose of the present study was to determine the effect of metacognitive therapy (MCT) on symptoms of fear of negative evaluation in social phobia disorder patients.Materials and methods: This study was carried out as a controlled clinical trial. Participants were referred from clinics in the city of Shiraz, Iran, and 19 patients were selected. They were randomly assigned to either the experimental or the control group. After running the pretest, which was done using the fears of negative evaluation scale (FNE) and social phobia symptoms assessment questionnaire (SPSAQ), the experimental group received 8 weekly metacognitive intervention sessions, while the control group received no intervention. Post-test and follow-up (after 3 months) were performed using the same tools.Results: The results of analysis of multivariate covariance showed that MCT had a significant effect on alleviating the symptoms of fear of negative evaluation (p<0.05).Conclusion: This intervention emphasizes on the promotion of efficient adaptive and flexible skills through metacognitive processes and their effect on a decrease in fear of negative evaluation in patients suffering social phobia disorder.

Background and purpose: There has been no objective evaluation of the rate of medical errors in Iran; it seems a disproportionate attitude is the main hindrance to reporting of such errors. Considering the role of the chief managers in executive functioning of every institution, this study has been carried out with the aim of surveying the attitude of chief managers of Mazandaran University of Medical Sciences towards voluntary report of medical errors.Materials and methods: In this descriptive cross-sectional study, chiefs, managers, chief nurses, supervisors and head-nurses from 32 hospitals affiliated to Mazandaran University of Medical Sciences took part. A self-sufficing questionnaire in two sections containing closed questions, in order to determine experience of medical errors and also to study their attitude towards voluntary report system of medical errors in hospitals was implemented. The questionnaire was based on a review of studies and had validity and reliability of 79% in a pilot study.Results: In this study, out of 278 (54 %) of questionnaires collected, 110 (39.6%) managers had experienced medical error, 190 (%68.4) stated that in the hospital they work, errors are reported. Most chief managers (%95.7) thought that reporting the medical errors would improve patient safety.89.6 % of the managers suggested the need for a different approach in executive policies. Majority of responders (%85) disagreed with an absolute punishment policy, in case of a medical error.Conclusion: Most hospital managers are in favor of a system for reporting and analyzing the medical errors. It seems that establishing a systematic and non-individual reporting and assessing the errors is a crucial step forward.

Background and purpose: Gynecomastia -benign proliferation of male breast glandular tissueoccurs due to increased ratio of estrogen to androgen activity. Considering the lack of studies on the effects of Tamoxifen on gynecomastia in Iran, and also scarcity of such studies in other countries, this study was conducted to determine the effect of Tamoxifen in the treatment of gynecomastia.Materials and methods: In this quasi-experimental study, patients with idiopathic gynecomastia, after obtaining consent, were treated with Tamoxifen (10-20 mg/day) for 6 months. At baseline and after starting treatment each month, criteria such as pain, tenderness and breast size were investigated and recorded. Criteria of response to treatment were decreased breast size and tenderness. The data analysis was done by Wilcoxon, Friedman, McNemar and Repeated measurements tests.Results: Thirty patients entered the study, at baseline 24 patients had tenderness, but in the third and also the sixth month of treatment this number decreased to 2 patients (p<0.05). In the third month, the mean decrease in breast size compared to baseline was 12.869±9.79 mm (p<0.05) and in the sixth month 24.70±19.71 mm (p<0.05). The size also had a significant decrease during treatment (p<0.05).Conclusion: Based on the results of this study, Tamoxifen is an effective medication for gynecomastia and considering the amount of reduction in breast size and tenderness, this medication is suggested for treatment of gynecoastia.

Background and purpose: Oral lichen planus (OLP), a common disease reported to be a premalignant lesion in some studies, may potentially lead to the development of oral squamous cell carcinoma. This study aims to investigate the prevalence of malignant transformation in patients with OLP.Materials and methods: In this retrospective study, 386 patients diagnosed with OLP based on the criteria of the World Health Organization (WHO) from 2006 to 2009 in Shiraz were studied.Results: Four patients (1.03%), one man and three women, showed malignant transformation. All malignant transformations occurred in red OLP types and tongue was the most common location.Conclusion: The findings of this study confirm the hypothesis that patients with OLP have a high risk of developing malignant transformations. Hence, it is recommended that OLP patients be monitored annually for early detection of possible malignant transformation.

Background and purpose: The presence of methanol in different types of drinks has caused problems and concerns. Therefore, developing a simple qualitative method to detect methanol in these products seems necessary. In this study, a new easy low-risk sensitive and accurate method based on chromotropic acid (CA) has been suggested for the qualitative detection of methanol in various types of drinks.Materials and methods: This study was conducted based on the conversion of methanol to formaldehyde to make a specific purple complex between formaldehyde and Chromotropic acid in an extremely hot and acidic environment. In this study two series of solutions with concentrations of 1, 5, 10, 20, 30, 40, 50 mg/L of methanol in distilled water and 10, 50, 100, 200, 400, 500, 1000 mg/L of methanol in ethanol 60o were prepared to determine the detection limit of the suggested method.Results: The result of the test was positive and a change into purple was observed in the concentrations of more than 10 mg/L in aqueous solution, and 500 mg/L in ethanol 60o, respectively.Therefore, the detection limit of this method was determined to be 10 mg/L for the detection of methanol in the solutions without ethanol and 500 mg/L in ethanol 60o solutions. Application of small and calculated amounts of reactants in low aqueous medium led to the elimination of heat.Conclusion: The suggested method can qualitatively detect methanol in different type of drinks easily and with no need for especial laboratory equipments and high technical knowledge in a short time.Therefore, it can be used as a semi-control method for the qualitative detection of methanol in various types of drinks.

Churg-Strauss is a disease with a prevalence of one to three cases per 100 thousand people. This disease is usually observed in the patients with a history of asthma being treated with steroids whose steroid therapy has been discontinued in the process. This patient was a 62-year-old woman with asthma who was treated for 6 months. Five days before she referred to the hospital, she developed skin involvement in her body. Drooping in the left wrist and her two ankles was evident. Eosinophilitic vasculitis and degenerative changes along the nerve pathway were reported in the nerve biopsy. Methylprednisolone pulse therapy 1 g daily for three days followed by Anoksan (150 mg daily) and Prednisolone (60 mg daily) tablets were administered. Lesions began to recover on the fifth day of hospitalization and after a week they completely disappeared. It can be concluded that in asthmatic patients who suffer from the change in clinical conditions, especially skin lesions, the Churg-Strauss disease should be considered as one of the differential diagnosis.