مجله دانشگاه علوم پزشکی مازندران
پیاپی 108 (دی 1392)

Background and

Oral route is the most frequently used route for drug administration and tablets are the most popular oral drug forms. The study of drug-excepient compatibility is an important process in development of a stable solid dosage form. Incompatibility between drugs and excipients can alter the stability and bioavailability of drugs, thereby affecting its safety and/or efficacy. In this study, the effects of formulation ingredients under aging and environmental factors on physical properties of atenolol tablets were evaluated.

Atenolol tablets were obtained by the Direct Compression method and using different excepients. After conducting some initial tests, tablets were subjected indifferent temperatures and humilities for six months. From different formulations, the atenolol release and disintegration time were analyzed. Differential scanning calorimetry (DSC) and Fourier transform infrared spectroscopy (FTIR) were used to determine the possible interactions between drug and excipients.

The results of drug release from different formulations after 3 and 6 months storage in 25°C/60% relative humidity (RH) and 40°C/75%RH showed significant differences among various times. Under all the storage conditions, atenolol tablets showed an increase in disintegration time. DSC and FTIR did not show any interaction.

The results of dissolution and disintegration time showed that keeping atenolol tablets for three or six months in different conditions caused significant changes in the drug release and disintegration. Moreover, no change was observed in the physical stability of tablets.

Background and Colonoscopy is an invasive short-lasting procedure causes the patient's considerable pain, discomfort and anxiety. Therefore, various types of sedation and analgesia techniques have been used during the procedure. The aim of this study was to compare the quality of sedation/analgesia of propofol-fentanyl and midazolam-meperidine combinations in patients undergoing elective colonoscopy. Eighty-three patients scheduled for elective colonoscopy under sedation were enrolled in this randomized double-blind study. In propofol-fentanil group, patients received fentanyl (1 µg/kg) and propofol (0.5 mg/kg) followed by an infusion of 25 µg/kg/min. Group midazolam-meperidine received meperidine (0.7 mg/kg) with midazolam (0.03 mg/kg). The assessment included measurements of quality of sedation, heart rate, blood pressure, oxygen saturation, and evaluation of the recovery time. The systolic blood pressure, heart rate, and percent of blood oxygen saturation (SPO2) remined stable during the procedure. Sedation level was higher in propofol-fentanil group. Recovery time was 12.68 ± 4.90 and 25.75 ± 2.07 minutes in the propofol-fentanil and midazolam-meperidine groups, respectively (P = 0.023). Propofol-fentanil can provide better sedation, satisfaction and analgesia than midazolam-meperidine during colonoscopy. Therefore, it can be recommend in patients scheduled for elective colonoscopy.

Background and

Nowadays one of the major problems around the world is traffic accidents and its consequences. Annually, 25 to 27 thousands of people lose their lives in motor vehicle accidents in Iran. This study aimed to investigate the effective factors on death caused by road accidents.

Information of deceased persons during the years 2009 to 2000 in suburban accidents of Mazandaran province, Iran, were reviewed and analyzed retrospectively. Variables of gender and age of the driver, type of vehicle, head injury during the accident, getting to the hospital after the accident and location of the accident were investigated. Kaplan-Meier and Cox proportional hazards model were used for data analysis.

The variables, head injury during the accident and getting to the hospital after the accident, had a significant effect on risk of death caused by road accidents.

Given the significant relation of the type of injury and medical services after road accident with death, emergency actions and allocation of health resources in high-risk areas are recommended to reduce losses due to accidents.

Background and Rosa damascena Mill in Iranian folk medicine is used for treating digestive disorders. We assessed the antispasmodic effects of extract of the leaves of this plant on ileum contractions in Wistar rats; possible mechanisms were investigated, too. In this experimental study, 48 male Wistar rats (150-200 g) were divided randomly into six groups of eight members, including control group and the groups received extracts of Rosa damascena Mill, propranolol, naloxone, L-nitro-arginine methyl ester (L-NAME), and calcium chloride. To evaluate the effectiveness mechanisms, ileum was placed adjacent to antagonist drugs of β-adrenergic receptors, opioid and inhibitor of the synthesis of nitric oxide, and also under the influence of different doses of calcium chloride. The observed effects were recorded. Then, the percent changes were calculated. Statistical analysis was done using parametric tests of repeated measuring design, ANOVA and t tests. Cumulative extract of Rosa damascena Mill (100, 500 and 1000 mg/k) decreased ileum contractions induced by KCl (P < 0.0001). Propranolol and naloxone significantly decreased the inhibitive effect of the extract on contractions induced by KCl (P < 0.0010), but L-NAME was ineffective. Also, calcium led to the contraction of depolarized tissue through KCI and this contractile effect decreased significantly by the cumulative concentration of Rosa damascena Mill (P < 0.0010). Extract of Rosa damascena Mill probably decreases ileum movements of the rat through stimulating the β-adrenergic and opioid receptors and voltage-dependent channels, and it may be used to treat digestive disorders.

Background and Monitoring quality of rivers water and awareness of its health status over time and identifying vulnerable zones are considered as essential steps towards sustainable development and efficient management of the environment. This study used multivariate statistical methods for analyzing water quality and awareness of rivers state in the Mazandaran province, Iran. The monthly data of the rivers water quality parameters including electrical conductivity (EC), pH, NO3-, PO43-, CO32-, HCO3-, SO42-, Ca2+, Mg2+, K+, Na+, sodium absorption rate (SAR), Na%, permanent hardness (Per.H) and temporary hardness (Tem.H) during the 2011-2012 was collected. The principal components analysis, cluster analysis and spatial analysis were used to provide better results. There were overlapped between many of the measured parameters. TDS, pH, SO42-, NO3-, and PO43- were optimization variables that could describe the water quality with 94.96% of variance. Results of grouped stations showed the relative quality of rivers water was lower in the western areas of the Mazandaran province. Relative situation of some stations including Baliran, Doab, Pol Mergen, Pol Sefid and Kercha was critical. Multivariate statistical analysis is able to process vast amounts of data, simultaneously. Determining important rivers water quality parameters can reduce costs and identification of homogeneous regions can play a significant role in integrated environmental management.

Background and

Lead (Pb) is an element that due to high solubility in aqueous solutions can cause poisoning in consumer. Therefore, removal or reduction of Pb (II) from industries wastewater and contaminated drinking water is inevitable. In recent years, particular attention to the variety of natural structures and cost-effective materials to remove pollutants from aqueous solutions has been made. Bivalve mollusk shell is one of the cheap-price natural adsorbents can remove these contaminants.

The requested adsorbent was derived from the shells of marine bivalve mollusk collected from the shores of the Caspian Sea, and then was powdered. After contacting the adsorbent with different concentrations of lead solution in laboratory conditions, readings of the secondary concentration by atomic absorption spectrophotometer were conducted. Experimental design of this study was central composite design (CCD), is one of the methods of response surface methodology (RSM). There were 31 standard samples.

The best pH for absorption by the adsorbent is 6. Increasing adsorbent dose to 0.55 mg/l and the contact-time to 45 minutes was optimal. The mechanism of adsorption followed the Langmuir isotherm and adsorption process was monolayer and homogeneous. Quadratic interaction for pH parameter was significant (P = 0.0001).

Bivalve mollusk shells have the ability to adsorp Pb (II). This ability is due to the mechanism of adsorption and ion exchange. Maximum efficiency is related to the interaction between pH and optimum adsorbent dose. As compared to other adsorbents such as epicarp etc. that their availability is follows their consumption, usage of absorbent due to its low cost and abundance can be economically justified.

Background and Therapeutic effects of Stachys lavandulifolia include anxiolytic effects; also، it has beneficial effects in rheumatic diseases، genital tumors and cancerous ulcers but it showed adverse effects on liver and kidney. We investigated the subacute and subchronic toxic effect of Stachys lavandulifolia water extract in rat. The animals were randomly divided into four groups as cases and one group as control respectively received doses of 50، 100، 150 and 200 mg/kg of the water extract and normal saline، intraperitoneally، daily، for 14 days. At 8th and 15th days، the serum levels of alanine transaminase (ALT)، aspartate aminotransferase (AST)، alkaline phosphatase (ALP)، glutathione (GSH)، creatinine (Cr)، and blood urea nitrogen (BUN) were evaluated in different groups. On the subacute study، there was significant increase of AST and ALT levels at dose of 100 mg/kg، BUN level at doses of 100 and 200 mg/kg، GSH level at all doses except the dose of 150 mg/kg compared to the control group (P < 0. 05 for all). On the subchronic administration، only the AST level significantly increased at the dose of 200 mg/kg compared to the control group (P < 0. 05). Stachys lavandulifolia extract caused severe toxic effects on the liver and weaker toxic effects on the kidney; therefore، it should be used warily in the public.

Background and Differences of race, region and type of diet can be effective in the urinary excretion of calcium. Calcium stones are the most common kidney stones. The most common metabolic disorder predisposing to stone formation is hypercalcuiria. The aim of this study was to comparison the urine level of calcium to creatinine ratio in children suffering from urolithiasis and the control group. In this case-control study, the children of 1 month to 15 years of age with urinary stone returned to Nephrology clinic of Taleghani Hospital (Gorgan, Iran), as case group, and other children referred to this center without kidney stone in urinary tract in ultrasonography, as controls, were studied. The ratio of calcium to creatinine was analyzed in 202 cases and 302 controls. Data were analyzed using chi-square and Mann-Whitney tests. In the age groups of under 7 month (27.5% vs. 4%), 7 month to 2 years (33.3% vs. 0%), and older than two year (73.5% vs. 14.4%), calcium to creatinine ratio was significantly higher than the control group (P < 0.05). The results showed that the ratio of urine calcium to urine creatinine in children suffering from urolithiasis was higher than control group. Therefore, using this ratio to screen amonge predisposed cases can be suggested.

Background and

Bipolar disorder is a severe psychiatric disorder with a variety of natural courses and manifestations, and a recurrent nature. The aim of this study was to determine the effective factors on recurrence using Andersen-Gill counting process model.

In an ambidirectional cohort study (4 years retrospective and 1 year prospective from 2007 to 2012), 255 patients (141 men, and 114 women) with bipolar type I disorder and history of hospitalization in Zare psychiatric center (Sari, Iran) were studied. Demographic, psychiatric and other variables related to recurrence were gathered from patient's medical records. Andersen-Gill counting process model via Statistical Package of STATA was used to determine predictive variables of recurrence.

693 recurrences occurred during the 5 years follow-up period; all the patients experienced recurrence at least once, 29 patients (11.4%) only once, 90 (35.3%) twice, 87 (34.1%) thrice, 25 (9.8%) four times, 21 (8.2%) five times, and 3 (1.2%) six time. Counting process regression model showed that the number of previous episodes and psychiatric family history in first-degree relatives (hazard ratio > 1; P < 0.05) increased the probability of recurrence; and presence of psychotic features in each recurrence decreased hazard of recurrence (hazard ratio < 1; P < 0.05).

Bipolar disorder has a high rate of recurrence. Predictor variables include number of previous episodes, first-degree relatives’ psychiatric family history and presence of psychotic features in each recurrence.

Background and Today, environmental pollutions are of the most important issues and hazardous in food safety around the world. Given the importance of salt and water in dietary, and extracting them from Maharloo Lake, Iran, this study aimed to investigate the concentrations of heavy metals, as environmental pollutions, in salt and water of this lake at different seasons. In order to monitor heavy metals, including chromium (Cr), mercury (Hg), arsenic (As), cadmium (Cd) and lead (Pb), water and salt samplings were done in each season from August 2009 to May 2010. Using atomic absorption, the concentration of the mentioned metals was determined after digesting the samples. The order of concentration of detected metals in different seasons in salt was Cr > As > Cd > Pb > Hg, and in water was Cr > As > Hg > Cd > Pb. In salt, the highest concentrations of Cr, Cd, Pb, and As were detected in spring and of Hg was seen in summer. Also in water, the highest concentrations of As and Cd were detected in spring, of Cr and Hg in summer, and of Pb in autumn. In summary, it could be concluded that the changes in the concentration of metals during different seasons was caused by the changes in the inlet water and human activities, especially agricultures. In addition, compared to Iranian standard, determined concentrations of Pb and Hg in salt samples were lower.

Background and Expanding of acquired immune deficiency syndrome (AIDS) is such an important issue that one of the main goals of World Health Organization (WHO) is increasing of knowledge about human immunodeficiency virus (HIV)/AIDS in general population. Thus, in Iran forth developing program, prevention programs for HIV/AIDS has been mentioned. AIDS is a behavioral disease, so education is necessary for changing high-risk behaviors. In this descriptive study, 9207 married women at the age of 10-49 years who were coming to health centers were selected by systematic method sampling. We collected data by a valid questioner. Total score for knowledge and attitude was 100. 85.4% of women were living in cities and 14.6% in villages. Most of them were homemaker (93.4%). The women were trained about HIV/AIDS but just 13.4% of them had complete awareness. The first source for getting information was television and then, health care providers. The mean score for knowledge was 81.6 ± 17.7 and there was a significant relation between the score of knowledge and women''s age, educational level and career (P < 0.001). Findings showed limited knowledge about HIV/AIDS so we need to improve methods of training and use variety in our awareness program for married women at the age of 10 to 49. It is necessary to keep the rights of patients and increase social marketing for voluntary counseling and testing (VCT), care and treatment of people live with HIV/AIDS.

Background and Cold-smoking is one of the most common ways to increase the shelf life of fish during storage. This study aimed to extract and measure the polycyclic aromatic hydrocarbon (PAH) carcinogens, using high-pressure liquid chromatography (HPLC)-mass, fatty acids profile, nutritional value, and bacterial community in three widely-used species of smoked fishes [Rutilus frisii (Kutum), Liza aurata, and Hypophthalmichthys molitri] of Caspian Sea, Iran. Amounts of high molecular weight (HMW)-PAHs, as indicator of carcinogenic components in smoke, showed concentrations of 0.100, 0.039 and 0.033 µg/kg in smoked Hypophthalmichthys molitrix, Liza aurata and Rutilus frisii, respectively (P < 0.05). The concentration of Benzo[a]Pyrene was calculated in Hypophthalmichthys molitrix and Rutilus frisii 0.001, and in Liza aurata 0.004 µg/kg (P < 0.05). The amounts of ω-3 in Hypophthalmichthys molitrix, Liza aurata and Rutilus frisii were 15.79%, 11.18% and 8.74%, respectively (P < 0.05). The Poleyen index amounts (EPA+DHA/C16) were 0.30% in, 0.13% and 0.14% in Hypophthalmichthys molitrix, Liza aurata and Rutilus frisii, respectively (P < 0.05). High correlation was considered between amounts of lipids and PAHs (R2 = 0.56). Number of anaerobic bacteria in smoked Hypophthalmichthys molitrix, Liza aurata and Rutilus frisii was 5.26, 5.15 and 5.18 log ufc/g, respectively and amounts of total coliform (TC) was recorded 5.21, 5.23 and 5.20 in them, respectively (P < 0.05). Contents of PAHs, quality indexes and bacterial community were at the accepted ranges and the suitable unsaturated fatty acids (UFA) and Polyen index were considerable in studied fish.

Background and Internal assessment is an introduction for improving the quality and the first step of accreditation. Identifying the competencies and the weaknesses enables the organizations to choose the strategies to face environmental forces. This study aimed to identify the strengths and the weaknesses of hospitals in Gorgan and the Gonbad-e Qabus cities, Iran. This cross-sectional study was performed in Azar the 5th, Deziani, and Taleghani hospitals in the city of Gorgan and Shahid Motahari and Shohola hospitals in the city of Gonbad-e Qabus. Statistical Society was included 322 clinical and non-clinical staff of the hospitals. Data collection instrument was a questionnaire. The data were analyzed using ANOVA, t, and Pearson correlation tests. 83.5% of respondents considered desirable internal hospital environment and 16.5% of them considered undesirable. The weakest area was rewards and the strongest area was target. There were significant relationships between internal environment of hospitals and years of services (P = 0.030), ward (P = 0.008), and hospital (P = 0.021) but there were not significant relationships between internal environment of hospitals and age (P = 0.371), sex (P = 0.559), employment status (P = 0.527), and level of education (P = 0.110). Internal environment status was good from employee's viewpoint but rewards need to improve. It is necessary for managers to give rewards to personnel practice-basely and individually.

Background and Aerobic exercise has been recommended as an important strategy for management of cardiovascular diseases and endocrine-metabolic disorders. The aim of this study was to evaluate the effect of 6-weeks aerobic exercise training on oxidative stress and enzymatic antioxidants in postmenopausal women with hypertension. In a quasi-experimental study, 20 sedentary postmenopausal women with hypertension (age: 50-55 years) with borderline to stage 1 hypertension at baseline were randomly divided in two groups: exercise training (ET, n = 10) and control (n = 10). Training program consisted of 45-60 minutes of aerobic exercise at 40-60 percent of maximal heart rate, 3 sessions per week for 6 weeks. The control group did not change their activity. Blood pressure measurements and blood samples were collected at baseline and after six weeks to evaluate levels superoxide dismutase (SOD), malondialdehyde (MDA) and catalase activity. Data were analyzed by paired and independent t tests. Significant reduction in both systolic (P < 0.001) and diastolic (P = 0.008) blood pressure values was seen after exercise training which was accompanied by markedly increase of superoxide dismutase level (P = 0.004) and catalase activity (P = 0.001). Plasma malondialdehyde level was significantly reduced (P = 0.003) after exercise training. Six-weeks aerobic exercise was accompanied by significantly reduce resting systolic and diastolic blood pressure in postmenopausal women with hypertension; this protective effect of exercise may be related to increased antioxidant defense and decreased oxidative damage resuted from regular aerobic exercise.

Testicular cancer allocate for only 1% of all male cancers، that 1-2% of them، would be familial. Family history of testicular cancer will be major risk factor. In this study، noticing the fact that familial testicular cancers are rare، we introduce cases of familiar testicular cancer. The first case was a 39-years-old man that came with abdominal enlargement، pain، and painless palpable masses in right testis. Serum tumor markers showed alpha-fetoprotein (AFP) as 373 IU/ml and ß-human chorionic gonadotropin (ßHCG) as 216 IU/ml. The second case (his brother) was a 35-years-old man came to clinic with painless right testis enlargement. Serum tumor markers were normal. This patient underwent radical orchidectomy. Pathology reported classic seminoma limited to tunica vaginalis. Next، both of patients underwent chemotherapies. This study reveals that in familiar testicular cancer، one of the most important causes will be hereditary factors. For patients'' more survival and comfortability، early diagnosis via physical examination، serum tumor markers evaluation and sonography is important.

Canavan disease is an autosomal recessive leukodystrophy due to accumulation of N-acetyl aspartic acid (NAA) in brain، cerebrospinal fluid (CSF)، and urine characterized by early onset developmental delay، initial hypotonia progressing to hypertonia، sleep disturbance and macrocephaly. Brain magnetic resonance imaging (MRI) shows white-matter changes. The best method for diagnosis is determined NAA in the urine. We report a 30-month-old boy manifesting his symptoms when he was 6 months old. Brain MRI showed high signal intensity in T2 images. High-performance liquid chromatography (HPLC) and electroencephalography (EEG) were normal. His symptoms were generalized tonic-clonic seizures at the age of 22 months and spasticity، hypotonia، macrocephaly، joint stiffness، and sleep disturbance at the age of 30 months. The patient was diagnosed by assessing NAA level in urine.

Burn wound is a suitable environment for growth and reproduction of microorganisms. The tissue in the burn wounds is not live and do not have blood vessels; so, polymorphonuclear antibodies and systemic antibiotics cannot diffuse into it. Thus, the condition of the wound is provided for the growth of bacteria and opportunistic fungi such as Candida, Mucor, Rhizopus, Penicillium, and Aspergillus. While the widespread use of topical and systemic antibiotics and early surgical, surveillance or isolation procedures of burn patients led to a significant reduction in wound bacterial infections, the incidence of invasive fungal infections in burn patients with extensive burns has increased. The ubiquitous presence of fungi in the environment and patients’ fungal flora, in combination with the immune system dysfunction, make burn patients susceptible to serious fungal infections. Conventional methods for the identification of fungi include direct microscopic examination and culture; however, recently, for faster and more reliable diagnosis, polymerase chain reaction (PCR)-based molecular methods are recommended. As diagnosis of fungal infection remains challenging, surveillance, prophylactic and empirical treatment is necessary. To improve the safety and efficacy of antifungal therapy, the causing species, infection site, patient’s age, and kidney and liver function should be considered in selecting the appropriate agents.