مجله دانشگاه علوم پزشکی مازندران
پیاپی 144 (دی 1395)

Background and Stress-induced hyperglycemia (SIH) is common in patients in intensive care units (ICUs). It is associated with adverse consequences such as increased length of stay in ICU, increased risk of infections, and high mortality. This study examined the prevalence of SIH and its therapeutic approach in an intensive care unit.
A retrospective descriptive-analytical study was performed using the medical records of patients in ICU in Imam Khomeini Hospital, Sari, Iran, 2013. All patients stayed more than 24 hours and experienced stress hyperglycemia were included in the study. The guidelines of American Association of Clinical Endocrinologists/American Diabetes Association (AACE/ADA), 2009 were used as standards for management of the SIH.
Eight hundred medical records were evaluated. The mean age of patients was 59 ± 22 years. The rate of SIH was 5.7% in 667 non-diabetic patients. The most common cause for ICU admission was gastrointestinal disorders (34.2%). Among the patients with SIH, 63% had parenteral nutrition and 42.1% received corticosteroids. Sliding Scale Insulin (SSI) and infusion method were used in 26 (68.4%) and 12 patients (28.9%), respectively. The mortality rate was 44.7%.
Compared with other studies, lower prevalence of hyperglycemia in ICU was seen in current study, so, blood glucose monitoring (every 6 h) was associated with better outcomes. In this study, most of the patients received SSI, but according to the AACE/ADA guidelines, insulin infusion method is preferred for management of hyperglycemia. In order to reduce the episodes of hypoglycemia and mortality, insulin infusion method is recommended for controlling hyperglycemia.

Background and Seroma formation is a common complication after inguinal surgery and lymphadenectomy. Phenytoin as an antiepileptic medication has also antimicrobial effects that can accelerate wound healing and reduce pain. The aim of this study was to evaluate the role of phenytoin in prevention of seroma formation following inguinal lymphadenectomy.
In this experimental study, 30 Wistar rats were divided into two groups. After inguinal lymphadenectomy the intervention group received topical phenytoin 1% and sterile normal saline 0.9%, while the control group received only normal saline. Ten days after surgery, the incidence and volume of seroma were determined and tissue samples were sent for histopathological examination. Data analysis was done in SPSS V.20 using Chi-square and Independent T-test.
The results showed that edema (P=0.050) and congestion (P=0.001) were considerably lower in phenytoin group while fibrosis was significantly higher in this group (P=0.017). The mean volume of aspirated seroma in intervention group and controls was 0.73±0.24 and 1.31±0.27 ml, respectively (P=0.014).
Phenytoin can reduce edema and congestion in wound region and also leads to faster healing by increasing fibrosis. The topical application of phenytoin causes direct access of the medication to the target site and prevents the risk of systemic side effects.

Background and Cyclophosphamide (Cyclo) is a common chemotherapy medicine that reduces male fertility. Various antioxidant agents have been used to reduce the side effects of chemotherapy medicines. Zinc oxide nano particles (nZno) have been introduced as a potent antioxidant. This study aimed at investigating the protective effects of nZno on testis tissue structure in Cyclo treated mice.
We conducted an experimental study in which 15 adult male mice were divided into three groups (n=5 per group) and treated for 4 weeks as: 1) control: normal saline (0.1 cc daily), 2) treatment I: Cyclo (15 mg/kg, once a week) and 3) treatment II: Cylo (15 mg/kg kg, once a week) nZno (5mg/kg, daily) intraperitoneally. Twenty four hr after the last administration of drugs, the animals were euthanized and right testes were isolated and fixed. Five-micrometer testicular tissue sections were prepared according to routine histotechnique process and were studied by light microscope.
Compared with the control group, cyclophosphamide reduced the diameter and septal epithelium thickness of the seminiferous tubuli, primary spermatocyte, spermatid, and spermatozoid (P≤0.05) while co administration of nZno with cyclophosphamide prevented these changes (P≤0.05). nZno also prevented the luminal extension and epithelial disorganization of seminiferous tubuli induced by cyclophosphamide.
nZno could prevent testicular tissue changes and reduction of spermatogenic cell counts induced by cyclophosphamide.

Background and Adolescent-mothers communication about reproductive health is one of the strategies that could decrease youth risky behaviors. This study aimed to find out the desire for communication, its level and content between adolescents and their mothers on reproductive health.
In a descriptive study, 655 high school girls in Mazandaran, Iran were selected via stratified sampling (2015-16). The level of communication between adolescents and their mothers or any problem on this, the desire to talk to mothers and their active interaction about reproductive health was examined by adapted standard questionnaires.
The mean score for adolescent’s knowledge on reproductive health was 5.76±1.45 out of 10. The mean scores for level of communication between adolescents and their mothers, any problems in the communication and the desire to talk to mothers were 34.12± 6.10, 31.83± 4.31, and 7.58± 4.17, respectively. The main topics of talks were puberty (83.7%) and sexual relationship (15.5%). The maximum duration of talks was 5-10 minutes (33%) in the preceding six months (35.4%). About one third of the girls were satisfied with the talks to their mothers (34.5%) and felt comfortable in having a discussion with them about reproductive health (31.3%).
Most adolescents did not communicate with mothers about reproductive health and their knowledge on it was weak. The adolescent-mothers communication and solving any barrier on this should be addressed. Nevertheless, implementation of programs on reproductive health sensitize both adolescents and mothers on the importance of having communication about it.

Background and Multiple drug resistance in Enterobacteriaceae has restricted the available options for treatment of infections caused by these bacteria. The aim of this study was to investigate the pattern of multidrug resistance and cross-resistance in Enterobacteriaceae causing nosocomial infections in intensive care units during 2014-2015 in eighteen governmental hospitals in Mazandaran province, Iran.
A cross-sectional descriptive study was performed in which antibiotic susceptibility test to routinely antibiotics was determined by MIC method and "broth micro-dilution” was done according to CLSI.
A total of 35 strains including Klebsiella pneumoniae (24), Escherichia coli (6), and Enterobacter spp (5) were extended-spectrum β-lactamases producer. The prevalence of multidrug resistance in Klebsiella pneumoniae, Escherichia coli and Enterobacter spp were 95.83%, 66.6%, and 80%, respectively. Among the isolates 28.57% exhebited cross-resistance to aminoglycoside antibiotics and 40% were found with cross-resistance to third- and fourth-generation cephalosporins.
Regarding the high prevalence of multidrug resistance and the emergence of cross-resistance to different categories of antibiotics among Enterobacteriaceae causing nosocomial infection, more effective measures should be taken including implementation of infection control programs, isolation of patients infected by multidrug resistance bacteria, and antibiotic stewardship in hospitals.

Background and Coronary artery disease (CAD) is the most common cause of death in many countries. Therefore, identification of risk factors for CAD is essential to carry out preventive measures. The aim of this study was using logistic regression model to determine the risk factors for cardiovascular disease in a population aged above 35 years.
This cross-sectional study was carried out using the records of 477 patients over 35 years of age who had angiogram in Fatima_Zahra Heart Hospital in sari during 2015 to 2016. The information extracted included the age, gender, location, family history of premature CVD, smoking, body mass index (BMI), blood pressure, fasting blood sugar (FBS), total cholesterol, triglycerides (TG), HDL cholesterol, and LDL cholesterol. The patients were divided into two groups of with or without at least one vessel with stenosis above 50%. Logistic regression model was used to study the risk factors associated with CAD.
The patients included 158 male and 319 female, mean age 58.45± 10.7 years. There were 268 (56.2%) cases who had at least one vessel with stenosis above 50%. The multivariate logistic regression model showed age (OR=1.57, P=0.003), gender (OR=7.38, P The multivariate logistic regression model showed some factors such as gender, HDL cholesterol, triglycerides, fasting blood glucose and age as the main risk factors for developing CAD.

Background and The most effective way to achieve a correct diagnosis of oral lesions is appropriate biopsy and pathological examination. This study evaluated the concordance between clinical and histopathological diagnoses in patients with oral lesions.
A cross-sectional descriptive-analytic study was performed in 206 patients who had biopsies in a center for oral and maxillofacial pathology in Sari, Iran during 2011-2015. Demographic characteristics including age and gender were recorded. Also, consistency and color of the lesion, the biological process, anatomical location, exophytic or flat lesion, surface shape, peripheral or central, specialty of physicians and clinical diagnosis, and consistency with the histopathologic diagnosis were studied and analyzed by Chi-square and Fisher, Kappa test.
Clinical diagnosis was consistent with histopathologic diagnosis in 77.1% of the cases. Correct clinical diagnosis in malignant lesions (75%) was more than that in benign lesions (72.7%). Compared with peripheral lesions, the diagnosis of central lesions was more in agreement with histopathologic diagnosis (81.1%), amongst which radicular cysts were diagnosed correctly in most of the cases (coefficient agreement: 92%). The most correct clinical diagnosis was in the smooth lesions (68.3%) and gum lesions (68.5%). The highest coefficient agreement with pathology results was observed in maxillofacial surgeons (86.5%).
A high rate of clinical diagnosis and pathology reports corroborated each other, nevertheless, significant rate of mismatch still exist which should decrease by suitable approaches.

Background and The family physician is obliged to deliver qualified and comprehensive services according to the people`s need for provision, protection and improvement of their physical, mental, and social health. This study aimed at investigating patients’ satisfaction from urban family physician program in Mazandaran province, Iran, 2015.
In this cross-sectional study, 1500 patients were sampled through multi-level random method from several cities in Mazandaran province. Data was collected by a researcher-made questionnaire consisting of 6 dimensions and 30 items including services, services delivery, services accessibility, physicians, assistants and picture of services (5 items in each dimension). Its validity was confirmed by experts and its reliability was verified by internal consistency calculated for each dimension; 0.84, 0.86, 0.92, 0.79, 0.83, and 0.85, respectively.
We found that patients were only relatively satisfied with physicians (P According to this study, authorities in health care sector must work on increasing patients’ satisfaction with the urban family physician program to deliver better health care services.

Background and Despite studying the relationship between breast cancer and dietary factors in previous studies, ignoring the cancer phenotype can affect the association between diet and breast cancer. The aim of this study was to determine the association between dietary patterns and HER2 among Iranian women.
In a case-control study, 150 new cases with ductal or lobular in situ or invasive breast cancer and without a previous history of the disease were selected. Also, 150 age-matched controls were included in the study. Data including demographic characteristics, food frequency, and physical activity were recorded using relevant questionnaires. Also, the information regarding HER-2 factor was obtained from patients records. Factor analysis was used to identify major dietary patterns. The association between these patterns and breast cancer was examined by logistic regression analysis.
Two major dietary patterns were identified. After adjusting for potential confounders, participants who had higher scores for unhealthy dietary patterns (mayonnaise, French fries, soft drinks, pickles, red or processed meat, potatoes, sweets and desserts) and healthy dietary patterns (fruits and fruit juices, vegetables, low-fat dairy products, spices, nuts, fish, egg, legumes and low intake of hydrogenated fats) were more (OR: 4.12, 95%CI: 2.31-7.3) and less (OR: 0.17, 95% CI: 0.30-0.95) prone to develop breast cancer, respectively. A healthy dietary pattern reduced the risk of HER-2 positive breast cancer (OR: 0.11, 95% CI: 0.04-0.25).
Healthy dietary pattern reduced the overall risk of breast cancer and was inversely associated with HER-2 positive tumors, indicating a poor prognosis of the disease.

Background and Color vision deficiency is an X-linked recessive inherited disease that affects men more than women. The aim of this study was to determine the prevalence of color vision deficiency among patients with amblyopia aged 10 to 30 years old.
A cross-sectional population-based study was performed in 2846 participants, aged 10 to 30 years in 2013-15 attending the eye clinic in Boali Hospital, Qazvin, Iran. All participants completed a questionnaire and were examined by an optometrist and an ophthalmologist. The examinations included visual acuity (VA), refraction errors, and color vision test. Data was analyzed in SPSS ver.19 applying Chi-square and t tests.
The participants were 36.54% male. The prevalence of amblyopia was 9.24%. Of the total participants, the prevalence of color vision deficiency was 0.98%. Among this population 53.57% were seen in amblyopic patients. Among individuals with amblyopia (n= 263) 15 were found with color vision deficits. There was a significant difference in prevalence of color vision deficiency between amblyopic and non-amblyopic individuals (P There was significant difference in prevalence of color vision deficiency among patients with amblyopia and non-amblyopic participants.

Background and Group poetry therapy has been implemented to overcome psychological problems associated with different diseases. Cancer seems to be one of the main targets for group poetry therapy. The aim of this study was to explore the effectiveness of group poetry therapy on the hope, quality of life, and some psychological problems in patients with breast cancer.
A sample of 60 participants were randomly divided into intervention (n=20) or control (n=40) groups. Eight sessions of weekly poetry therapy was carried out for the intervention group. Miller’s Hope Scale, EORTC-QLQ-C30, and DASS21 questionnaires were administered before initiation of therapy. Then, the intervention group completed the questionnaires at one week and two months after the intervention. IBM SPSS V. 21 was applied for data analysis.
In this research, poetry therapy improved patient’s hope after one week and eight weeks of intervention (the score in both cases increased from 54 to 67, P= 0.03 and P= 0.05, respectively). Also, the scores for quality of life showed an increase from 186 to 197 after the intervention (P= 0.02 and P= 0.06 respectively). Moreover, physical complaints and stress decreased to some extent after the last session of therapy (P= 0.08 and P= 0.09, respectively).
This study showed that group poetry therapy as a preventive or palliative intervention could improve patient’s hope and quality of life and also reduce physical complaints and stress in short-term and medium-term.

Background and Venomous bite and specific morphological features of scorpions are the most important reasons for paying attention to scorpions. Anxiety and stress caused by scorpions and their stings are amongst the important health issues in many countries especially in Iran. This study was conducted on scorpions’ fauna in Darmian County, South Khorasan province, Iran.
In this study, 21 districts in Darmian were sampled including plains, mountains, residential, non-residential, rural and urban areas. Sampling effort was conducted monthly in 2015-16. Scorpions were collected by actively searching in day and night using pitfall trap. The specimens were identified by appropriate identification keys.
Totally 685 specimens were collected. Five species including Mesobuthus eupeus, M. caucasicus Androctonus crassicauda, Orthochirus scrobiculosus, and Compsobuthus matthiesseni were identified from Butidae family. The most frequent species was M. eupeus (n= 373, 54.5%), while A. crassicauda (n= 22, 3.2%) was recognized as the least frequency species.
Androctonus crassicauda (black scorpion) was found as the most dangerous species in Iran, so, alongside care programs for scorpionism in Darmian, prescription of anti-scorpion serum in cases stung by scorpion should be done by considering the coloring of scorpion and residential area of injured person.

Background and Nonalcoholic fatty liver disease is one of the most common causes of chronic liver disease and is a major public health problem worldwide. In recent years, the prevalence of nonalcoholic fatty liver disease has increased in children and adolescents. This study aimed to investigate the effect of silymarin on children with nonalcoholic fatty liver disease.
In this randomized crossover clinical trial, 40 children with nonalcoholic fatty liver disease were divided into two period treatment groups. Patients in group A received 140 mg silymarin capsules, three times a day in the first three months, and after one-month washout period they received placebo for three months. Group B received placebo at first and then silymarin. Liver enzymes, LDL, HDL and triglyceride levels were measured at baseline and after the first and second stages. At the end of three months, the patients underwent ultrasonography.
The study included 36 boys and 4 girls. After treatment with silymarin no significant changes were seen in weight, AST, ALT, HDL, LDL and TG levels of patients compared with those of the control group (P>0.05). However, fatty liver grade decreased significantly after treatment with silymarin (P=0.02).
As previous studies on adults, our results showed beneficial effects of silymarin on reducing fatty liver grade in children with nonalcoholic fatty liver disease. Larger studies with longer treatment periods are recommended in order to achieve comprehensive results.

Background and Access to safe drinking water is of the utmost importance in public health around the world. Presence of contaminants, such as secondary bacterial growth and endotoxins could reduce the quality of water resources. This study aimed at investigating the occurrence, seasonal variation, and removal of endotoxins in a conventional water treatment plant (WTP) in Tehran, Iran.
A total of 36 samples was collected on a monthly basis from raw water and treated water in each uint of Tehran-pars drinking WTP during summer and fall (2015). Endotoxin concentrations were assessed using the Endpoint Chromogenic Limulus Amebocyte Lysate (LAL) detection method. Furthermore, turbidity, heterotrophic plate count (HPC) and pH measurements were done to assist in the analysis of data.
The mean values for the total endotoxin activities in summer and fall in the raw water were 44-54.5 and 17.62-54.5 Eu/ml, respectively. The results demonstrated a 34% decrease in endotoxin activity following the full-scale treatment process at the WTP. The highest concentration of endotoxin was detected in summer. Coagulation, clarification and sand filtration resulted in the highest endotoxin removal (38.16 %), while chlorination contributed to the concentration of total endotoxins by 5.6-6.7%.
Water treatment processes aiming at the removal of particulate matter in the WTP revealed the most effective removal rates of total endotoxins. However, endotoxin contamination exists in the drinking water treated.

Background and Vesico-ureteral reflux (VUR) is one of the most common diseases encountered by urologists. Ureteral re-implant has been the only method of surgery for VUR correction. In recent years endoscopic injection of several agents (bulking agents) has been proposed as a treatment. The aim of this study was to evaluate the therapeutic efficacy of endoscopic subureteric injection of total blood nucleated cells and platelet.
A clinical trial was done in 17 patients with VUR aging 18-35 years old in Mashhad Imam Reza Hospital, Iran, 2012-2015. The participants were randomly selected and placed under endoscopic injection following voiding cystourethrography (VCUG). Three months later the patients were evaluated using clinical findings, urine culture and VCUG. If the VUR persisted, the second injection was performed three months after the first one.
There were 17 patients including 13 females and 4 males, mean age 22.8 ± 4.9 years. The procedure achieved success in 89% of renal units after the first injection and 94% after the second one. We observed no major complications.
Our pilot interventional clinical trial showed that endoscopic injection of total blood nucleated cells and platelets is an effective method for treatment of VUR in adult patients.

Background and Coronary artery stenosis is a progressive process associated with artery calcification. Although the role of matrix Gla protein (MGP) is not completely clear but its expression in vascular smooth muscle cells (VSMCs) and sub-endothelial macrophages suggests a role in vascular calcification. The rs1800799 is one of the polymorphisms oriented within transcription factor elements in the promoter region of the MGP gene that may modify MGP expression patterns resulting in artery calcification. In this study, we examined the serum level and rs1800799 polymorphism of MGP gene promoter in patients with stenosis of coronary artery in Tehran.
One hundred sixty three individuals undergoing coronary angiography were divided into two groups: patients (n=100) and controls (n=63). The lipid profile, serum MGP concentration and rs1800799 genotypes were measured by routine laboratory, ELIZA, and RFLP-PCR assays, respectively.
In this study, we observed positive relationships between the two groups in LDL, total cholesterol, and TG levels (P 0.05). Also, genotype and allele distributions did not differ significantly between the cases and controls (P> 0.05). Furthermore, the serum levels of MGP were not significantly different between genotypes (P> 0.1).
In this study, the rs1800799 genotype distribution and serum MGP value were not significantly associated with coronary heart disease. Moreover, the serum MGP level showed no major role in the progression of coronary artery stenosis.

Background and Removal of emerging pollutants from water and wastewater is a great concern in environmental issues. In this study the Taguchi method as one of the major methods for experimental designs was used to assess the removal of atenolol from aqueous solution by multi-wall carbon nanotubes.
In an experimental study in a batch system to investigate the factors affecting atenolol absorption (pH, contact time, absorbent dose, and initial concentration of atenolol) Taguchi design was used in four levels with L-16 matrix. The properties of the absorbent were determined using Fourier Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy (SEM), and Transmission Electron Microscopy (TEM). The absorption isotherm models were analyzed by Design Expert 6.
The optimum conditions for pH, contact time, MWCNT dose and initial concentration of atenolol to affect the absorption on multi-walled carbon nanotubes were 7, 20 minutes, (0.5 gr/l), and (10 mg/l), respectively. The removal efficiency and absorption capacity in optimum condition were 94.8% and 16.76 mg g-1, respectively. The data was evaluated by absorption models such as Langmuir, Freundlich and Dubinin Radeshkevich. The equilibrium data was well fitted with Freundlich model (R2=0.93).
This study showed that multi-walled carbon nanotubes as an effective absorbent have a high potential to remove atenolol from water and wastewater.

Background and Nitrite is used for preserving food, especially in processed meat products. Processed foods containing nitrite are highly used in many countries. This harmful substances in water, soil and ecosystem endanger the health of people. In this study, we examined the effect of sodium nitrite on liver enzymes and histological structure of the liver in streptozotocin-induced diabetic rats.
In this study, 60 adult male Wistar rats were divided into six groups (n= 10 per group): a control group, experimental groups receiving 175 and 350 mg/kg/day sodium nitrite, a diabetic control group, and diabetic groups receiving 175 and 350 mg/kg/day sodium nitrite for 60 days. Diabetes was induced in rats by intraperitoneal administration of streptozotocin (65 mg/kg). Blood samples were collected after anesthesia and the serum AST, ALP, and ALT were measured. Also, liver tissues were removed to investigate the histological changes. Statistical analysis was done by one way variation and student’s ANOVA Test. P values less than 0.05 were considered significant.
The AST, ALP, and ALT levels significantly increased in diabetic groups and the group receiving 175 and 350 mg/kg sodium nitrite (P The results showed that sodium nitrite can induce adverse effects on the liver, especially on the liver in diabetic rats.

Background and In order to improve the efficiency, effectiveness and quality of health care services, it is necessary to manage their organizational knowledge and information. In this paper, the readiness of Iran’s health centers for establishing knowledge management was studied.
We conducted a descriptive study in which the status of some indicators for the establishment of knowledge management was studied. The indicators included the leadership, human resources, technology, culture, structure and processes of Iran’s health care centers. A questionnaire was administered that consisted of items scored according to Likert scale from very high (5) to very low (1). The research population included the managers and administrators in health centers who were selected from 15 provinces. Data analysis was done in SPSS V.16.
The indicators of information technology 3.24±1.06, organizational processes 3.21±1.04, human resources 3.21±0.93, organizational structure 3.19±0.84, and organizational leadership 3.16±1.05 were in appropriate state for establishing knowledge management. But the organizational culture 2.91±0.99 was found to have inappropriate condition.
Health policy makers are needed to plan for enhancing health care centers readiness for establishing knowledge management. The poor state of health centers in organizational culture calls for appropriate planning to improve its sub-indicators such as creativity and critical thinking, collaboration between experienced staff and newcomers, institutionalization of knowledge among the staff, supporting innovation in knowledge and teaching methods, and performance evaluation based on the individuals’ contribution in the organization.

Background and Tobacco use has an increasing trend. This study aimed at comparing the processes of motivation theory in the prediction of tobacco use in male high school students in Noshahr, Iran.
This cross sectional study was carried out in 440 high school students in Noshahr. The subjects were chosen through stratified random sampling. Data was collected using a questionnaire consisting of demographic questions and 55 items based on the constructs of protection motivation theory. The reliability and validity of the questionnaire was confirmed. Data analysis was done in SPSS applying Pearson correlation coefficient and linear regression tests.
The processes of coping appraisal (β=0.40) and threat appraisal (β=-0.19) could together predict 22.9% of the will for not using tobacco. The prediction rate of tobacco use behavior by these two processes was 25.6% in which the role of coping appraisal (β=-0.33) was more predominant than that of the threat appraisal (β=0.31).
The present study showed that the cognitive intervening process of coping appraisal is more successful in the prediction of the protection motivation and tobacco use behavior. So, enhancing self-efficacy and efficiency of response and reducing the perceived costs for not using tobacco among the students could be used as a principle that aims at reducing tobacco use.

Background and Periodontitis and gingivitis are inflammatory diseases in supporting tissues of tooth. Mast cells are inflammatory cells that can participate in destruction of connective tissue in periodontal diseases. In this study we evaluated mast cells count in gingival tissues in individuals with periodontal diseases and compared that with those in healthy people.
This case-control study was done in 60 samples obtained from patients with advanced periodontitis (n=15), moderate periodontitis (n=15), gingivitis (n=15), and healthy tissue samples (n=15, control group). Biopsy specimens obtained during flap and crown lengthening surgery were stained with toluidine blue and hematoxylin eosin.
Mast cells count were significantly different between four groups (P0.05). Also, mast cells count did not reveal any significant difference between advanced periodontitis and moderate periodontitis (P>0.05). Moreover, we found no significant relationship between mast cells count and degree of microscopic inflammation (P=0.09)
Mast cells are believed to play a role in pathogenesis of periodontal diseases, but further studies are suggested to clarify this role.

Background and Application of three-dimensional scaffolds with the ability to simulate a three-dimensional in vivo environment has opened new perspective on targeted differentiation and therapeutic use of stem cells. In this study we examined the compatibility of CD93 stem cells with biodegradable pcl- gelatin scaffold.
In this experimental study, three-dimensional scaffolds made of PCL -gelatin using electrospining synthesis and its molecular structure was tested by SEM electron microscopy. The scaffold surface was disinfected by UV ray. The hematopoietic CD93stem cells of those isolated previously were divided into two groups including normal cultured (plate) and culture on scaffolds (scaffold cell). The survival and growth of the cells were measured through MTT assay and electron microscopy at 7, 14, and 28 days after culturing.
Electron microscopic analysis on the seventh day showed appropriate adhesion of CD93 cells on scaffold fibers and secretion of extracellular matrix. Survival rate of the cells at 7, 14, and 28 days after culturing were not significantly different between the two groups. But at the same days significant differences were observed in the Scaffold Cell group (P This study suggests that PCL nanofiber scaffolds has high compatibility with CD93 stem cells and proximity to this scaffold lead to increased survival and growth of the cells. Further studies on the treatment of tissue damage and scarring by CD93 stem cells using this scaffold can be effective in increasing treatment efficiency.

Background and The increasing growth of cosmetic surgeries, especially Botox has raised the need for further attention to this cosmetic treatment. The current study investigated the role of body image, social support and religious beliefs in predicting Botox cosmetic surgery in Kermanshah.
This causal-comparative study was performed in two groups of Botox applicants (n=330) and those who were interested in having Botox cosmetic surgery (n=310) attending skin care and beauty clinics. They were selected by convenient sampling in Kermanshah, Iran, 2014. Data was collected using three questionnaires: the Santa Clara Strength of Religious Faith (1997), the Zimet's Perceived Social Support (1998) and the Appearance Schemas Inventory developed by Cash (1990). Data analysis was done in SPSS V.19 applying discriminate analysis.
Significant difference was found between the two groups in predictive variables (P According to this study, the body schema of body appearance, social support by significant others, and perceived support by family play significant roles in predicting cosmetic surgeries.

Background and Knowledge on the risks of radiation during diagnostic imaging is necessary to protect patients against the hazards of ionizing radiation. The aim of this study was to investigate the level of knowledge of interns, radiology residents, radiology students, and staff about radiation doses received by patients in radiological examinations.
During a cross-sectional study, 163 individuals (interns, radiology residents, students, and staff in Kashan University of Medical Sciences) were asked to identify the average dose of radiation received by patients. A researcher-made questionnaire was administered. Average of correct answers in the groups was analyzed using the SPSS 16 software. The scores above 75%, 75-50%, 50-25%, and below 25% were considered as very good, good, moderate, and poor levels of knowledge, respectively.
The mean scores for the level of knowledge about the dose received by patients were 57.9±2.45% and 52.4±2.65% in the staff and radiology students, while it was 35.35±-1.65% and 41.35±6% in interns and residents, respectively.
In this study most of the radiology staff and students had good levels of knowledge about the radiation dose received by patients during diagnostic radiological methods. Therefore, revising curricula with more emphasis on radiation protection is recommended for medical interns and residents.

Background and This study aimed at comparing the influences of airway pressure release ventilation (APRV) and Synchronized Intermittent Mechanical Ventilation (SIMV) on cerebral hemodynamic and intracranial pressure in patients with traumatic brain injuries.
A clinical trial was carried out in 40 patients with traumatic brain injuries in the intensive care unit in Kamyab neurosurgery Hospital, Mashhad, Iran. The patients meeting the study inclusion criteria were randomly assigned into two groups; intervention (APRV, n= 20) and control (SIMV, n= 20). The ICP, CPP, MAP, pulse pressure and heart rate in both groups were measured before and after conditioning. Analysis of data was done using independent t-test in SPSS V.22.
The mean ICP remained unchanged in both groups (P= 0.421). After the intervention, the CPP, MAP, heart rate, and pulse pressure in APRV group were not significantly different compared with those in the two groups before the intervention (P> 0.05).
The results showed APRV as a safe mode that can be beneficial in patients with traumatic brain injury without concerns for increased intracranial pressure and hemodynamic disorders.

Background and Overproduction of free radicals after brain ischemia exacerbates brain infarction and edema specifically during early reperfusion. The scavenging property of water-soluble fullerene derivatives is proven, so, the aim of this study was to evaluate the effects of fullerenol nanoparticles on brain infarction and edema, especially oxidative damages during reperfusion in an experimental model of stroke.
The experiment was performed by three groups of rats (n=24): sham, control ischemia, and ischemic treatment. Brain ischemia was induced by 90 min middle cerebral artery occlusion (MCAO) followed by 24 hours reperfusion. The rats received fullerenol (10 mg/kg IP) immediately after termination of MCAO. Neurological deficit score (NDS), infarct volume, brain edema, and brain content of malondialdehyde (MDA) were assessed 24 hours after termination of MCAO.
MCAO induced neurological dysfunction (3.20±0.20), brain infarction (527±59 mm3), and brain edema (3.83±0.53%) in control ischemic group. The content of MDA increased in ischemic brain (5.30±0.11µg/mg protein) compared with that in non-ischemic brain (0.74±0.34µg/mg protein). Administration of fullerenol in ischemic treated rats significantly reduced neurological dysfunction (2.01±0.22), brain infarction (106±33 mm3) and brain edema (1.70±0.74%). Also, fullerenol decreased the MDA content of ischemic treatment group (0.78±0.16µg/mg protein) compared with that of the control ischemic group.
Our findings indicate that fullerenol nanoparticles, as a potent antioxidant, effectively reduce reperfusion-induced brain injury and brain edema possibly through scavenging property of free radicals.

Background and 2,4 dichlorophenol is one of the most important components of organochlorine. High resistance against degradation, creating odor and taste in water, high toxicity and being carcinogen have made this pollutant a great concern. Current study batch was done to investigate the adsorption of 2,4 dichlorophenol onto Magnetic Graphene Oxide Particles (MGO NPs).
The adsorption behavior of 2,4-dichlorophenol was studied in a series of batch experiments as a function of pH (3-11), contact time (0-120 min), and pollutant concentration (10-125 mg/L) at three different adsorbent dosages (0.1-1 g/L). Finally, pseudo-first-order, pseudo-second-order kinetic, Langmuir and Freundlich isotherm models and adsorption thermodynamic were studied in optimized conditions.
The results revealed in optimized conditions (pH=5, contact time=15 min, pollutant concentration= 10mg/l and adsorbent dose=0.75 g/l) maximum adsorption capacity and removal efficiency of 2,4-dichlorophenol were 84.74 mg/g and 100%, respectively. Langmuir isotherm (R2=0.9987) and pseudo-second-order (R2=0.9992) models were proved to be the best in describing the adsorption data. The thermodynamic parameters showed that the adsorption process was endothermic (ΔG= 57.7 to 119.15) and spontaneous (ΔG= -1.15 to -9.44).
MGO NPs have extended capabilities such as easy and rapid separation from sample and high potential in removing 2,4 dichlorophenol, so, it can be introduced as an appropriate adsorbent for removal of this pollutant from water and wastewater.

Background and In-vivo dosimetry is used to ensure accurate delivery of dose to tumors during radiotherapy. This study aimed at measuring the entrance doses without the build-up cap for patients undergoing 15MV radiotherapy and determining the percentage errors between doses measured by films and those calculated with a treatment planning system (TPS).
The study was performed on 30 patients with brain tumor undergoing radiotherapy by 15MV photons of a Siemens linac. A novel method was developed for in-vivo dosimetry, without the need to use build-up caps and was used to estimate conversion coeficients in a solid water phantom for various irradiation conditions with and without a 30º wedge for 5×5, 10×10, and 15×15cm2 field sizes and 80, 90 and 100cm SSDs. The conversion coeficients provided ratios of surface doses measured by gafchromic films to those of an ioniztion chamber for various conditions.
For 4 patients, more than 5% error was noted in in-vivo doses. The mean and standard deviation of errors between the doses measured and those calculated with TPS for the patients’ skulls were -2.23% and 3.36%, respectively. The conversion coefficients increased by increase in field size and decrease of SSD. The conversion coefficients for all irradiation conditions were greater for the fields with the wedge than those without it.
The novel dosimetry method developed for measuring the entrance dose without any need to use build-up caps usual in conventional dosimetry methods, not only makes no disruption in the dose reached to patient’s treatment volume, but also provides an accurate estimation of entrance dose in clinical situations.

Background and Interleukin-6 (IL-6) causes the progression of prostate cancer through pSTAT3, pERK1/2, and pAKT cell signaling proteins. Quercetin, an herbal antioxidant, has anti-tumor effect. The aim of this study was to evaluate the effects of quercetin on IL-6 gene expression, and the above cellular signaling proteins in PC3 prostate cancer cells.
In this experimental study, PC3 cells were treated with different concentrations of quercetin at 0, 10, 50, and 100 μM. Then, IL-6 concentration was determined in cell culture media. Also, total RNA and the cellular signaling proteins aforementioned were extracted from PC3 and used for determining IL-6 gene expression by quantitative real-time RT-PCR and western blot analysis, respectively.
The quercetin IC50 for PC3 prostate cancer cells was 100 μM. Elevation of quercetin concentration in cell culture media increased the IL-6 gene expression and protein synthesis. At 50 and 100 μM of quercetin, IL-6 protein synthesis increased significantly (P The effects of quercetin on PC3 cells could have resulted from reduction of pSTAT3, pERK1/2, pAKT, induction of the oxidative stress and generation of reactive oxygen species. Therefore, quercetin can be considered as a useful therapeutic agent in treatment of prostate cancer.

Background and 2, 4-dinitrophenol (2,4-DNP) is categorized as one of the priority pollutants that is used in pharmaceutical and chemical industries, pesticides, etc. In this study we aimed at investigating the biodegradation of 2,4-DNP by immobilized laccase on nano-porous silica beads.
An experimental study was conducted in which the enzyme was chemically cross-linked on the nano-porous silica beads. Temperature (40-60 ˚C), contact time (2-12 h), mediator concentration (1-3 mM), pH (4-6) and initial pollutant concentration (10-30 ppm) were considered. The high performance liquid chromatography was applied to measure the degradation of the pollutant.
The maximum removal of 2,4-DNP (91%) was achieved at T=50˚C, 2,4-DNP concentration of 10 ppm, mediator concentration of 1 mM, pH=5 and 12h contact time. ANOVA analysis showed that contact time and pH had the most and lowest effect on the process efficiency, respectively.
2,4-DNP was effectively degraded by laccase. The reusability and resistibility of the enzyme improved through immobilization. The immobilized laccase on nano-porous silica beads could be applied to remove a wide range of phenolic pollutants.

Background and Cognitive problems after traumatic brain injury may affect all aspects of life in injured people. One of these problems is visuospatial working memory deficit which was investigated in this study on patients with mild head injury.
We conducted a cohort study in 60 patients with mild traumatic brain injury (MTBI) and 60 healthy cases in Trauma Research Center (TRC) affiliated with Kashan University of Medical Sciences, Iran. The subjects were followed for 6 months after which Benton Visual Retention Test (BVRT) (form C, administration methods A and D) was used for their assessment. T test, Chi-square test and repeated One-way ANOVA were used for the analysis of data. P≤0.05 was considered significant.
The two groups were significantly different in their correct scores in administrations A and D of Benton test (P≤ 0.05). The results indicated a correlation between the sites of injury and number of correct scores in visual memories of MTBI patients (P=0.003).
Impaired spatial visual memory in MTBI patients in concordance with other findings in this field are in favor of significant functional problems in this group which mandates a more prolonged systematic approach and better follow up plans to overcome many hidden difficulties these people experience.

Background and Nowadays, human and financial losses caused by natural and non-natural disasters have a great impact on human health. This research was conducted to determine the ability of selected hospitals in crisis management according to the World Health Organization.
A descriptive study was done in which the authorities (n=45) in three selected hospitals (Razi, ValieAsr, and Shafa) in Mazandaran province, Iran were participated in 2015. Data was collected by world Health Organization check-list and was analyzed using numerical taxonomy in Excel software.
The check-list included five scales: general information, identification of the risks and the level of functional safety, structural safety, and non-structural safety. Compared with two public hospitals (Razi and ValieAsr) the overall safety level in private hospital (Shafa) was higher (57.84%). Considering the ranking and developmental status, except Vali-Asr hospital (0.5 0.75).
This study showed the need for a standard management system in crisis management and serious attention to general indices, risks and safety levels in hospitals.

Background and Type A acute aortic dissection is a serious life-threatening condition that requires emergency surgery. Development of complications and operative management may be affected by various factors. The aim of this study was to evaluate the risk factors and outcomes after surgical treatment of acute type A dissection.
A Cross-sectional descriptive study was done in two phases during March 2010 and June 2015, in Fatemeh Zahra Hospital, Sari, Iran. The research population included the patients who had surgery for treatment of type A acute aortic dissection. In phase I a checklist was completed (using the patients records, n=25) that consisted of demographic, clinical and imaging data, and the information that was recorded during the operation. In next phase, laboratory analysis and postoperative echocardiography were conducted for seven patients.
Phase I showed that none of the patients had Marfan syndrome, history of hyperlipidemia and diabetes. Frequency of other risk factors (history of hypertension, history of smoking, chronic pulmonary disease, renal failure, cardiac surgery, aortic arch involvement, bicuspid aortic valve, and cardiac tamponade) were found to be different in patients. In phase II, we observed death in three cases after being discharged from the hospital and prediction of morbidity rate was not possible due to low number of samples.
In this study, Gender and functional class were found as the risk factors in patients who had syrgery for acute aortic dissection.

Background and Several indices are involved in determining the levels of development in a country or a region. Among them, the most important is believed to be the health equity. The purpose of this study was to assess the level of health equity in selected cities in Mazandaran province, Iran, 2014.
A descriptive-analytic research was carried out in five cities in Mazandaran province including Babolsar, Sari, Tonekabon, Amol, and Noshahr. Relevant information was obtained from the management and planning organization database and health networks in these cities. Taxonomy was used for ranking the cities.
The level of development in different indices ranged as follows: mortality and birth: 0.57 in Noshahr to 0.86 in Sari, disease and accidents: 0.50 in Amol to 0.88 in Tonekanon, environmental health and work: 0.69 in Sari to 0.89 in Babolsar, family health and education: 0.26 in Sari to 0.82 in Amol, and social welfare: 0.82 in Sari to 0.96 in Tonekabon.
In this study none of the cities studied had an appropriate level in mortality and birth, and health and social welfare indices. Therefore, efforts should be made to facilitate services that could enhance these developing indices.

Background and The use of medicinal plants are suggested during pregnancy. In this study we aimed at assessing the knowledge, attitude, and practice of pregnant women on using medicinal plants during pregnancy in Sari, Iran.
In a cross-sectional study, 307 postpartum women referring to health centers were recruited in 2014. Data was collected using a validated questionnaire consisting of socio-demographic information and some items about the knowledge, attitude and practice on the use of medicinal plants during pregnancy. The data was analyzed using descriptive analysis, Chi-square and t-test.
The most familiar medicinal plants were mint (96.7%), sour orange blossom (89.6%), and cinnamon (85.7%). The most common reasons for using such plants during pregnancy were that they were believed to be safe and having no complications (80.5%). Almost half of women (48%) used at least one of these plants throughout their pregnancy of which mint (31%), sour orange blossom (28.5%) and sisymbrium sophia (22%) were the most common. Use of medicinal plants was advised to majority of the women by their mothers (37.8%). The majority of women (95.7%) had positive attitude towards using medicinal plants in pregnancy.
Use of medicinal plants during pregnancy is increasing and expectant mothers are positive about such uses. On the other hand, there is a lack of information about using medicinal plants in this time, therefore, raising the awareness of women and health care providers on advantages and disadvantages of medicinal plants during pregnancy is recommended.

Background and Dose calculations in trachea HDR brachytherapy treatment planning systems are greatly based on TG-43 protocol in which, all materials including air inside trachea are treated the same as water. The aim of this study was to survey the effect of air on dose calculations of Flexiplan treatment planning system in trachea HDR brachytherapy.
To evaluate the effect of air inhomogeneity, a neck-equivalent plexiglass cylindrical phantom was used. Dose measurement was carried out by EDR2 film. Treatment planning and irradiation were performed using Flexiplan software and Flexitron brachytherapy system, respectively.
The results showed that considering the air inside trachea as water increases the absorbed dose by 12% which can lead to increment of patient dose.
A significant difference was seen between dosimetry results in the two conditions. Therefore, taking the air similar to water has a considerable effect on dose calculations of trachea HDR brachytherapy and accuracy of treatment plan performed.

Background and In humans, SRY (sex-determining region of the Y chromosome) is the major gene for the sex determination which is found in normal XY males and rarely in XX males, and it is absent from normal XX females and from many XY females. There are several methods which can indicate a male genotype by amplification of SRY gene. The aim of this study was identification of the SRY gene for fetal sex determination in human during pregnancy using loop mediated isothermal amplification (LAMP) method.
A total of 18 blood samples were collected from pregnant women at 8 weeks of pregnancy and plasma DNA was extracted. For detection of SRY gene LAMP assay was performed using the DNA.
LAMP results revealed the positive reaction was highly specific only to samples containing XY chromosomes; while no amplification was found in samples containing XX chromosomes. Finally, it was proved that from samples collected 9 were male embryos (50%) and 9 were female embryos (50%). All visual components used in colorimetric assay could successfully make a clear distinction between positive and negative reactions.
The LAMP assay is a valuable tool for detection of SRY gene for fetal sex determination.

Background and Sexual self-disclosure as a psychosocial sense is defined as individual’s interpretation on how to express feelings in marital relationships. This study aimed at determining the predictors of female sexual self-disclosure in Tehran.
In this cross-sectional study, 200 married women in Tehran were selected by convenience sampling. Hurlbert Index of Sexual Desire and a demographic questionnaire were administered. Data was analyzed in SPSS V.20 applying descriptive and inferential statistics including Pearson, Spearman, ANOVA, and linear regression.
The average score for sexual self-disclosure was 56.16±14.60. Some variables including the participant’s age, age of husband, duration of marriage, and time of last delivery were found to have significant inverse correlation with sexual self-disclosure. In multivariate model, marital life, the interest level in spouse, and duration of marriage were significant predictors of sexual self-disclosure.
Sexual self-disclosure was found to be low in this study. It is believed that marital life, duration of marriage, and interest level in spouse play important roles in women's sexual self-disclosure. Communication skills are suggested to be taught in premarital classes to enhance sexual self-disclosure, satisfaction and happiness in marriage.

Background and Iron anemia deficiency and helicobacter pylori infection are common diseases throughout the world. The aim of this study was to evaluate the association between iron deficiency anemia (IDA) and H. pylori CagA infection among children under 5 years of age.
An analytical-descriptive study was performed in Hajar and Kashani hospitals in Shahrekord, Iran, 2014. We investigated the seropositive prevalence of H. pylori CagA infection in 59 children with IDA and compared the results with that of 69 sex- and age-matched non-anemic children using SPSS V.20.
The mean age of participants in case and control groups was 42±3 and 40±2 months, respectively. The controls and cases included 30 boys and 29 girls and 30 boys and 39 girls, respectively. In anemic children 50% were found to be positive for IgG anti-CagA while in non-anemic group 8% were detected. The results showed significant relationship between the two groups (P Helicobacter pylori infection may induce iron deficiency anemia and CagA virulence factor may play a role in the severity of anemia.

Background and Over-expression of GRP receptors for Bombesin has been reported to be found in malignant tissues, especially in prostate cancer. Here, we aimed at radiochemical and stability evaluation of a new bombesin derivative labeled with 99mTc via HYNIC as a chelating agent and Tricine/EDDA as coligands that might be used for diagnosis of prostate cancer.
In this experimental study (performed in 2016), the prepared bombesin was added to aqueous solution of Tricine/EDDA, then we added SnCl2, which was dissolved in HCl-containing solution. Finally the prepared bombesin was treated in 95 °C for 10 minutes. We investigated raiochemical purity using TLC and HPLC methods. Also, its stability in normal saline and human serum and percentage of protein-binding were studied.
Radiochemical purity was more than 98%. Stability in normal salin was 97.5, 96, and 95.5% after 1, 4, and 24 hours, respectively. Stability in human serum after 1 hour was more than 98% and after 4 hours was more than 92%. Percentage of protein-binding was 12.5, 14, and 16%, after 1, 4, and 24 hours, respectively.
This new bombesin derivative was easily labeled with 99mTc using exchange labeling and has some promising characteristics for prostate cancer detection.

Visceral leishmaniasis (VL) or kala-azar is a parasitic disease caused by Leishmania donovani complex. Evidence suggests that visceral leishmaniasis is prevalent in some areas of Mazandaran and Golestan provinces. This study aimed to investigate the cases and also determining the causative agents of VL in these provinces. In this study, seven VL patients (mean age 1.5 years) admitted to the pediatric departments in Sari Booali Sina and Gorgan Taleghani hospitals, 2013–2016, were examined. The most common clinical and laboratory findings included prolonged fever, hepatosplenomegaly, anemia, pancytopenia, and hypergammaglobulinemia. Blood and bone marrow (B.M) samples were taken. Direct agglutination test (DAT) and rapid rK39 strip test were used as serologic tests and B.M microscopic slides were checked by species-specific PCR to identify the parasite species. All patients had positive rK39 and DAT tests. Examination of bone marrow smears demonstrated amastigotes of Leishmania (Leishman bodies) in the samples. The species of Leishmania in all B.M smears was Leishmania infantum. According to the identification of L. infantum as the major agent of VL in Mazandaran and Golestan provinces, increasing physician awareness (especially pediatric specialists) of the disease and conducting control programs in these areas are recommended.

Tuberculosis is a major concern in patients with rheumatologic disorders under immunosuppressive therapy. In this paper a 67-year old woman is presented with seropositive rheumatoid arthritis and negative screening for latent tuberculosis. She was treated with infliximab since 22 months ago. She developed constitutional and respiratory manifestations and flare of articular symptoms during treatment by immunosuppressive agents. Tuberculosis clinical presentation and investigation tests including imaging, pleural effusion analysis and interferon γ release assay (IGRA) estimation and anti-tuberculosis treatment was initiated and dose of prednisolone was increased. Afterwards, constitutional respiratory and articular signs improved significantly. Beside of initial screening, attention to tuberculosis in patients being treated with biologic drugs should be done at any time.

Septic pelvic thrombophlebitis is one of the causes of resistant postpartum fever which can lead to ovarian vein thrombosis and significant complications. We report a case of a 30-year-old multigravida woman pregnant with twins presented with fever and abdominal pain after uncomplicated vaginal delivery. She was diagnosed with right ovarian vein thrombosis by Doppler ultrasonography and computed tomography. The patient received antibiotics and anticoagulant therapy. Clinical suspicion and rapid diagnosis of ovarian vein thrombosis during postpartum period in the setting of fever can save patients lives.

Oral hygiene products have been used widely among people since many years ago. Toothpaste and mouthwashes are the main products that are used for health and beauty and the demand for such dental products is high. These products include both chemical and herbal products. Plants form a large part of the surrounding nature, so they are the first choice for health problems. Nevertheless, due to the fast development of chemistry and lack of natural resources herbal products are replaced by chemical compounds. Compared with herbal products, chemical compounds are associated with more side effects, so using herbal drugs are more favorable and researchers are more interested to such products. In oral hygiene drugs the plant extracts affecting inflammation and bleeding are of significant interest to dental professionals. This article introduces one of the most common herbal drugs used as oral care product.

Background and Essential oils are volatile components of plants. Some essential oils with phenolic compounds have a strong antimicrobial properties. Probiotics are live microbial food supplements which beneficially affect host by improving its intestinal microbial balance, and they are well recognized as antimicrobial agents that compete with pathogenic bacteria and inhibit their growth. Various types of probiotic bacteria have different sensitivities to essential oils. Some essential oils increase the growth of probiotics and some others decrease the growth or inhibit that. Simultaneous use of herbal essential oils and probiotics is a new approach in preventing growth of pathogenic bacteria in food, therefore, this study aimed at evaluating researches conducted in Iran about the effect of medicinal plant essential oils on the performance of probiotic microorganisms.
A literature search was conducted in electronic databases including Pubmed, Science Direct, Elsevier, SID, Magiran, and Google Scholar and articles published from 2006 until 2016 (the last decade) were selected. The search keywords included medicinal plants, probiotics, and growth inhibition.
The studies showed that compounds found in essential oils have different functions on probiotic bacteria. In other words, in some cases they acted as amplifiers and in some they showed inhibitory effects.
Essential oils of oregano, olive leaf, malt, cinnamon, garlic, dill, cumin, soy, and peppermint have positive effects on the growth of probiotic bacteria, while Kelussia, thyme, Teucrium polium and simultaneous use of oregano and Ziziphora have negative effect on probiotic growth.