مجله دانشگاه علوم پزشکی مازندران
پیاپی 168 (دی 1397)

Background and purpose: Evidence suggest high prevalence of trigger finger (TF) in diabetic patients. Corticosteroid injection in the area of tendon sheath thickening is the first-line treatment of choice for TF. However, some studies indicated low efficacy of this method in diabetic patients. This study aimed at investigating the effectiveness of oral corticosteroids in diabetic patients with TF. In a clinical trial, 50 diabetic patients with trigger finger (n=106 digits) enrolled. The patients were treated with oral prednisolone 5 mg, three times a day for 2 weeks. They were then followed up based on Quinnell grading at 3 and 6 weeks, and 3 months. Data analysis was done in SPSS V17 applying Repeated measures ANOVA. At the end of the three-month follow-up, 84 fingers (79.3%) of patients who took oral prednisolone improved. The reduction of Quinnell grading was significant after medication (p<0.001). Positive correlation was observed between symptoms duration and disease severity at third month (r=0.37, p<0.0001). In addition, there were positive correlations between the number of fingers affected and diabetes mellitus duration (r=0.425, p=0.002), HbA1C (r=0.319, p=0.024), and 2HPP (r=0.29, p=0.041). Current study showed no local side effects of corticosteroids in patients receiving oral prednisolone. Therefore, it could be suggested as an influential treatment for trigger finger in diabetic patients, especially those with less than 6 months onset of symptoms, normal blood glucose control, less severity of the symptoms, and higher number of involved fingers.

Background and purpose: Ureaplasma urealyticum is one of the most common causes of Non-Gonococcal Urethritis (NGU). Asymptomatic clinical infection caused by this bacterium can cause malnutrition of the sexual attachment glands and its presence in semen contributes to lower fertility. The aim of this study was to identify Ureaplasma urealyticum in semen of infertile men using PCR method as an accurate diagnostic method. The PCR test was optimized by standard strain to detect Ureaplasma urealyticum and then was studied in terms of specificity and limit of detection (LOD). Semen samples were collected from 100 infertile men and each sample was divided into two parts: the first part was tested by semen analysis and the second part was tested by PCR method. DNA was extracted using phenol-chloroform method and the PCR test was done for detection of Ureaplasma urealyticum. Among the semen samples, 16 cases (16%) were found to be positive for Ureaplasma urealyticum. According to the spermogram test, the leukocyte level was also more than normal level in these samples (0-1 Mil/ml). Screening of infertile couples for Ureaplasma urealyticum infection in those without clinical symptoms, thereby performing timely antibiotic therapy play key roles in treatment of infertility. Hence, PCR method is introduced as a valuable and reliable technique to identify Ureaplasma urealyticum.

Background and purpose: Alopecia areata (AA), also known as spot baldness, is an autoimmune disease in which hair is lost from some or all areas of the body. Genetic factors are known to play a role in the onset of this disease. The HLA complex genes are primarily involved in AA. In present study, effect of HLA-DQA2 allele frequency was analyzed in Iranian AA patients and control samples. The study group comprised 30 patients with Alopecia areata and 15 healthy controls. Genomic DNA was extracted from whole blood using DNG plus method. Polymerase chain reaction with sequence specific primers technique (PCR-SSP) was performed to detect HLA-DQA2. The association between HLA-DQA2 allele and some risk factors such as family history, anemia, and the onset of the disease was analyzed. Patients included 13 females and 17 males (mean age 26.3 ±12.5 years) and the controls were five females and 10 males (mean age 30.1±5.8 years). The frequency of HLA-DQA2 allele in AA patients (93.33%) was not significant compared to that of the controls (76.66%) (OR 0.94, 95% CI =0.018-1.018, p>0.05). No association was found between the disease and family history of AA (OR=0.09; 95% CI=0.01-0.119, P= 0), and onset of disease (OR =1.015; 95% CI=0.95-1.07, p=0.607). But significant correlation was observed between AA disease and anemia (OR =0.017; 95% CI=0.02-0.179, p=0.001). This study did not show strong correlation between HLA-DQA2 allele and developing Alopecia areata. The HLA-DQA2 allele was associated with anemia, but not related to family history and the onset of disease.

Background and purpose: MicroRNA regulation of cancer-related pathways has a major effect on cancer development. MiR-429 is a member of miR-200 family with an important role in metastasis. There are many studies on the association between miR-429 and liver, bladder, bowel, and gastric cancers. In this study, we investigated the expression changes of E2F3 genes after transfection of MCF-7 cells using pre-miR-429 and anti-miR-429 as the potential targets of miR-429. In this experimental study, E2F3 was predicted as the potential target of miR-429 using using miRNA bioinformatics tools. MCF-7 cells were then transfected with both mir-429 precursor and inhibitory vectors. RNA extraction and cDNA synthesis were done after 48 hr. Expression of miR-429 and target gene were determined by qRT-PCR. The comparison between the results of untransfected cells group, transfected with pre-miR-429 group, and transfected with anti-miR-429 group showed that down-regulation of miR-429, increased the expression level of E2F3 in cells transfected with miR-429 inhibitory vector (9.38 folds). Expression level of E2F3 decreased in cells transfected with pre-miR-429 vector (5.3 folds). Low expression level of miR-429 in breast cancer was found to be effective in bone metastasis, although in ovarian cancer and colorectal carcinoma, resulted in decreasing invasion and matastasis. In current study, the expression level of E2F3 decreased when transfected with pre-miR-429 vector and increased when transfected with anti-miR-429 vector, therefore, miR-429 could be a potential target in breast cancer therapy.

Background and purpose: Colorectal cancer is one of the most common cancers in the world and Iran. This cancer is a multifactorial disease that is induced by interaction of various genetic and environmental factors. In this study, we investigated the interactions between different environmental factors and candidate polymorphisms of two genes in colorectal cancer X-ray repair cross-complementing-1(XRCC1) and Oxo guanine DNA-glycosylase 1 (OGG1), which play roles in the DNA repair pathway and maintaining the integrity of the genome. This case-control study was conducted in 150 patients with colorectal cancer and 150 healthy controls selected from hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences. Polymerase Chain Reaction - Restriction Fragment Length Polymorphism (PCR-RFLP) was used to determine the allele of the polymorphisms. After determining the different genotypes, the interaction of these genotypes with environmental risk factors in two groups of patients and controls was analyzed and compared. The study showed that XRCC1 (Arg399Gln) polymorphism in body mass index and obesity was significantly correlated with colorectal cancer (p= 0.009). Also, the Lur race was found to be highly susceptible to developing colorectal cancer (p= 0.003), but there was no significant correlation between these items and other risk factors and OGG1 (Ser326Cys) polymorphism in colorectal cancer. In this study, XRCC1 Arg399Gln gene polymorphism was significantly associated with obesity and Lur race had a high potential for developing colorectal cancer.

Background and purpose: Coronary artery disease (CAD) is a complex disease that is caused by both environmental and genetic factors. Methylenetetrahydrofolate (MTHFR) enzyme is associated with metabolism of homocysteine and its impaired function is considered as a risk factor for developing CAD. Some variants are involved in decreased activity of MTHFR and its deficiency. The polymorphism of C677T (rs1801133) seems to be a significant variant that is related with CAD. The purpose of this study was to determine the relationship between MTHFR C677T gene polymorphism and susceptibility of CAD. This case-control study was performed in 71 patients with coronary artery disease and 71 healthy subjects (control group). Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to genotype MTHFR polymorphism. The mean ages of subjects in case and control groups were 58.2±8.9 and 46±13.9 years, respectively (P= 0.0000). The case group included 37 (52.1%) males and 34 (47.9%) females. In control group, there were 38 (53.5%) males and 33 (46.5%) females. The frequency of CC, CT, and TT genotypes in C677T polymorphisms was 59.2%, 35.2%, and 5.6%, in CAD patients and 62%, 32.4%, and 5.4%, in controls, respectively, indicating no significant differences between the cases and controls
(p= 0.937). The frequency of T allele was 40.8% in cases and 38% in controls which also showed no significant difference between the two groups (P= 0.864). Current study found no relationship between MTHFR C677T gene polymorphism and CAD. However, further studies in larger population are recommended to achieve better understand this relationship.

Background and purpose: Influenza is a seasonal respiratory illness that affects all age groups and causes excess mortality. Identifying the clinical manifestations and complications could be of great value in preventing the flue pandemic. Recent H1N1 pandemic is associated with some unusual findings such as thrombocytopenia, leukopenia, and lymphopenia which are not reported in other types of Influenza. Herein we investigate the hematological manifestations of influenza patients. This study included all patients with flu symptoms attending Sari Imam Khomeyni Hospital and Qaemshahr Razi Hospital, winter 2015. H1N1 influenza infection was confirmed by polymerase chain reaction from nasopharyngeal specimen received through nasopharyngeal swabs according to the National Committee of Influenza guidelines. CBC and WBC differentiation were performed to detect leukopenia, anemia, or thrombocytopenia. In this research 96 patients including 53 (55.2%) females and 43 (44.8%) males (mean age: 43.6±16.9) were studied. Mean WBC of patients were 6.9±2.62×103/cc and leukopenia was detected in 22 (22.9%) patients. The mean platelet count was 100×103/cc and 36 (37.5%) patients were thrombocytopenic. Mean hemoglobin levels were 6.1±1.12 g/dL and anemia was seen in 68 (70.8%) patients. There was no significant association between age, thrombocytopenia and leukopenia. In this study, thrombocytopenia, leukopenia, and anemia were detected in patients infected with H1N1 influenza.

Background and purpose: Organic chlorine pollutants are stable in the environment and dangerous to the health of living organisms. Among these compounds, polychlorinated biphenyls (PCBs) can be carcinogenic to humans and affect brain function, nervous system, reproductive system, and the immune system. They could enter the body through many ways including eating or drinking contaminated water and food such as chicken egg. Sampling of 4 brand of chicken eggs was performed in all seasons in Tehran, Iran 2017. The mixed solvent of Hexane: Dichloromethane (same ratio) was used for extraction applying ultrasonic method. Then, the two phases were separated using concentrated sulfuric acid. They were then condensed by a rotary machine with a vacuum pump under a gentle nitrogen gas and purified using silica gel column or florisil. Finally, the concentration of each PCB was measured by the GC-MS device. In all samples, the mean polychlorinated biphenyls (1.40±0.3 pg WHO-TEQ /g fat) was lower than the standard range and the highest concentration was associated with PCB 28 (mean value= 0.802 pg WHO-TEQ / g fat). One of the brands (B) had the highest average of PCBs, and the most contaminated eggs were found in winter (1.822 pgWHO-TEQ/g fat). In this study the average of each PCB was lower than the standard values in different types of eggs, indicating no risk to the consumers.

Background and purpose: Unwanted fertility is rarely studied among men.The aim of this study was to investigate the frequency of unintended pregnancy and its related factors in married men in South of Tehran, Iran. This descriptive-analytic study was conducted in 507 married men aged 23-49 in 2017. Demographic characteristics of the participants, their fertility history and knowledge on this issue were recorded. To analyze the data, single and multiple logistic regressions were conducted. The majority of participants reported history of pregnancy in their wives (95.1%). Approximately 37% of married men experienced at least one unwanted pregnancy. Adjusted multivariate logistic regression showed that being married more than once (AOR [Adjusted Odds Ratio], 95% CI= 2.74; 1.07-7.13), low level of comfort in the use of contraceptive methods (AOR, 95% CI= 10.06; 1.95-51.9), more than two live births (AOR, 95% CI= 2.49; 1.60-3.88), having three children and more (AOR, 95% CI= 6.70; 3.51-12.79), and doubts about marriage durability (AOR, 95% CI=0.25; 0.08-0.81) were associated with unwanted pregnanies . More focus on the factors associated with male experiences of unintended pregnancy could reduce this problem. Providing care for fertility and sexuality, trainings on the correct use of contraceptive methods to men in healthcare centers could also be of great benefit in reducing the rate of unwanted pregnancy and illegal abortions, especially in socioeconomically vulnerable populations.

Background and purpose: Female reproductive empowerment refers to the ability and rights to make free decisions in reproductive activities such as number of children and birth intervals. This study was designed to investigate the relationship between childbearing motivations and women reproductive empowerment. In this descriptive-correlational study, 810 women living in both urban (n=500) and rural (n= 310) areas participated. They were selected via two stage cluster sampling in Sari healthcare centers, 2017. Data were collected using a demographic-reproductive characteristics checklist, the Childbearing Questionnaire (CBQ), and Women's Empowerment Questionnaire. Data analysis was done applying independent t-test, one-way ANOVA, Pearson correlation coefficient, and linear regression. There was no significant association in the mean score for women reproductive empowerment in urban and rural areas (91.65± 12.86, 91.46±13.14, respectively, P= 0.593). The present study showed that women reproductive empowerment was directly associated with positive dimension of childbearing motivations (β=0.13, P <0.001) while it was inversely associated with negative dimension of childbearing motivations (β= -0.30, P <0.001). Also, women employment status (β=0.11, P= 0.003), husband's educational background (β=0.13, P= 0.029), and age of the last child (β= -0.07, P= 0.021) were amongst the factors affecting women reproductive empowerment. Women reproductive empowerment is associated with diferent socio-economic factors among which husbands' educational level is believed to be highly effective. Therefore, appropriate planning on this issue is of great benefit in improving women reproductive empowerment.

Background and purpose: Iran is one of the top ten countries in the world with disaster. Hospitals have a major role in dealing with disaster-related injuries. The purpose of this study was to assess the level of preparedness in Mazandaran province hospitals in dealing with disasters in order to identify the deficiencies and comparing current conditions with national standards. In this cross-sectional study, all hospitals affiliated with Mazandaran University of Medical Sciences and Mazandaran Social Security Organization (n=28) were evaluated in 2017. Data were collected using the National Standard Toolkit for Hospital Preparedness. The overall score and the scores for every component were recorded and the level of preparedness were presented according to four levels. The relative preparedness level of hospitals in dealing with disasters was moderate (65.5%). The overall levels of disaster preparedness in the hospitals affiliated with Mazandaran University of Medical Sciences and the social-security hospitals were moderate (63%) and favorable (75%), respectively. The hospitals affiliated with Mazandaran University of Medical Sciences, were found to have good (n=4), moderate (n=14), and poor (n= 5) levels of preparedness. The hospitals of the Social Security Organization were ranked as good (n=2) and moderate (n=3) in disaster preparedness. Most of the hospitals in Mazandaran province, like other regions in Iran, have poor level of disaster preparedness. Therefore, more planning is needed to enhance the hospital’s level of readiness in all dimensions.

Background and purpose: Fish is an important source of protein for human and is an important part of the diet, so, studying the concentration of heavy metals in commercial fish could be helpful in evaluating the risk of fish consumption. A total of 60 fish samples from four different species including anchovy, white, perch, and trout was randomly collected in fall 2016 from Rast Fish Market. After sample preparation and microwave digestion, the amount of heavy metals were determined by inductively coupled plasma optical emission spectrometer (ICP-OES). The US Environmental Protection Agency's (EPA) method was used to estimate the health risks associated with exposure to heavy metals in fish samples. The highest concentrations of heavy metals included mercury in whitefish (1.29 ± 0.23 μg/g), lead in whitefish (4.54 ± 0.75 μg/g), cadmium in salmon (0.07 ± 0.01 μg/g), arsenic in whitefish (1.36± 0.15 μg/g), nickel in whitefish (0.61 ± 0.07 μg/g), tin in whitefish (0.63 ± 0.05 μg/g), and chromium in fish perch (1.52 ± 0.04 μg/g). Non-cancer risk for all heavy metals in all the species was less than 1. The concentration of metals in species studied was in acceptable level, indicating no risk of toxicity. According to current results, fish consumption does not lead to adverse health effects.

Background and purpose: Leukemia is a group of cancers caused by accumulation of malignant white blood cells in the blood or bone marrow. The aim of this study was to investigate the efficiency of hypnotherapy on pain relief, death anxiety, resilience, and healing of cancer cells in patients with acute myeloid leukemia treated with chemotherapy. A quasi-experimental study was carried out in which the research population were 86 patients of whom 26 (aged 30-50 years old) were selected via convenience sampling. They were randomly assigned into either experimental group or control group. Flow cytometry tests were done to confirm acute myeloid leukemia. The McGill Pain Management, Connor-Davidson Resilience scale, and the Collett-Lester Fear of Death Scale were administered to collect the data. Hypnosis therapy (six sessions) was done in experimental group. Data were analyzed applying analysis of covariance in SPSS V22. Hypnosis therapy was found to have significant effects on mental dimensions in experimental group compared to the control group (P= 0.039). Follow-up investigations showed more changes in death anxiety compared with other two dimensions in experimental group (6.67). Laboratory results indicated the onset of inflammatory reaction in experimental group. Hypnotherapy is a powerful method in caring for cancer treatment.

Background and purpose: Bisphenol A (BPA) is a toxic environmental pollutant that is released from different industries. The aim of this study was to investigate bisphenol A adsorption by activated carbon production from almond shell applying response surface methodology (RSM). In this descriptive-analytic study, activated carbon production from almond shell was used as adsorbent which was prepared using standard methods. The variables were pH, initial concentration of BPA, and adsorbent dose. RSM was applied to optimize pH, initial concentration of BPA and adsorbent dose. The adsorption efficiency increased (by 84%) in high dose adsorbent (1.5 g), BPA concentration ≤60mg/l, and pH 3. ANOVA test showed that the surface response model had a significant linear relationship in the case of activated carbon. Activated carbon produced from almond shell, as a low cost adsorbent, could significantly adsorb bisphenol A in aquatic environments.

Background and purpose: The Child Mortality Index is an important part of the Millennium Development Goals. Every year, 6 million children die in the world. Death information is essential for prioritizing interventions and planning and recognizing the effectiveness of the interventions. This research was conducted to study the death of children aged 1-59 months in Ardabil province, Iran. All deaths in Ardabil province from 2011-2015 in children aged 1-59 months were extracted. The distribution of death was determined based on location, sex, and place of residence and the relationships between these items were investigated using SPSS V23. A total of 553 deaths was recorded and male death included 56.2%. Death at hospital occurred in 64.7% and death in urban areas accounted for 55.9% of all deaths. Death in children aged 1-12 months was observed in 57.1%. There was a significant relationship between sex and place of residence. The trend of death in children showed a rise during the 5 years studied. The main causes of death according to death records in Health Department and hospitals were congenital anomalies and chromosomal aberrations. The main causes of death could be prevented in children, therefore, precise planning is needed to reduce the mortality rate in this population. We observed similarities between the causes of death in hospital and the causes of death in the community, so, hospital data could be of great benefit in appropriate planning.

Background and purpose: The World Health Organization predicts more than 8 million deaths until 2030 as a result of tobacco use. Pictorial cigarette pack warnings have a major role on the cognitive and emotional reactions, and the first intention to smoking cessation. The aim of this study was to investigate the role of pictorial cigarette pack warnings on smokers’ attitudes and behavior. This cross-sectional study was done in 450 male smokers (>15 years of age) in Babol, Iran. They were selected using purposeful random sampling and data were collected by a researcher-made questionnaire. Data analysis was done in SPSS V19 applying one-way ANOVA and Pearson correlation coefficient. The mean age of participants was 42.5 ± 14.7 years. Pictorial cigarette pack warnings caused changes in feelings towards smoking (11.3%), feeling of danger (17.65%), reduced consumption (16.25%), and thoughts of quitting smoking (11.15%). Pictorial cigarette pack warnings were significantly associated with the attitudes towards smoking (p<0.001). Pictorial cigarette pack warnings play a role in changing the attitudes of smokers and reducing cigarette consumption, therefore, further attention is needed on creating more useful warnings.

Background and purpose: Stroke is one of the most common causes of death. This study aimed at evaluating the one-year prognosis in patients with stroke. In this descriptive cross-sectional research, 361 stroke patients admitted in Hamedan Sina Hospital, 2015-2016 were studied. Data were collected using a checklist on demographic characteristics, risk factors, Modified Rankin Scale (mRS) scores at discharge, 3 months, 6 months, and one year after stroke. Data analysis was done in SPSS V16 applying T test and Chi-square. Death occurred in 63 cases within the first year but 298 survived until the end of the study. The mean mRS scores at discharge or pre-death in people who died were significantly higher than those of the patients who survived at first year (4.31±0.71 and 2.44±1.09, respectively, p=0.001). Patients had a more favorable situation over time, so that the mean mRS score at the time of discharge was 2.5, three months later 1.8, six months later 1.3, and after one year decreased to 1.2. Hemorrhagic stroke, involvement of both hemispheres, higher mean age, opium and cigarette consumption, previous history of stroke, diabetes, heart disease, and multiple clinical signs at the time of stroke could lead to poor prognosis in patients.

Background and purpose: Minocycline is an antibiotic which has anti-inflammatory and anti-seizure properties. There is no reliable evidence on the effect of Minocycline on histological structures of cerebellar Purkinje neurons. This study aimed at elucidating this effect in epileptic rats. This experimental study was conducted in 24 rats which were randomly divided into three different groups (n=8 per group). In groups I and II epilepsy was induced by pentylenetetrazole at 40mg/Kg. Group I was administrated minocycline at 25 mg/Kg whereas group II was given normal saline at 25 mg/Kg for two weeks. Group III was the control that received only normal saline. The rats were all deeply anesthetized and cerebellectomized. All removed cerebella were stained by APAF-1 (Apoptotic Peptidase Activating Factor -1), then safe normal Purkinje neurons were counted. Data analysis was done applying Dunnett test. Significant difference was seen in mean number of normal neurons between groups I and II and the control group (p<0.001). Compared with group II, we observed a significant increase in mean number of normal Purkinje neurons in group I (p<0.01). Treatment with minocycline was found to have protective effect on Purkinje neurons in the cerebellum of epileptic rats.

Background and purpose: Cleft lip and cleft palate are the most common congenital defects in the jaw and face. These defects can make serious problems, such as facial deformity, nutritional problems, respiratory problems, and difficulties with social interaction. Awareness of the incidence of these defects in the community is important. In a systematic review and meta-analysis we aimed at investigating the prevalence of cleft lip and cleft palate in Iran. An advanced search was conducted in all credible databases to access relevant articles using related keywords until February 1, 2018. After removing the duplicate, irrelevant, and poor quality papers, 17 articles were included. Data were analyzed applying random effects model in RevMan5.3 software. Total number of samples in selected articles was 1,077,537 neonates. Prevalence of oral cleft, both cleft lip and cleft palate, cleft lip, and cleft palate was 1.24 (CI 95%; 1.10-1.38), 0.88 (CI 95%; 0.70-1.06), 0.34 (CI 95%; 0.28-0.40), and 0.35 (CI 95%; 0.27-0.43) in 1000 live births. The prevalence of this disorder was found to be higher in males (1.82 vs. 1.09). The overall prevalence of cleft lip and cleft palate in this study was lower than that in other countries in the Middle East and Asia. But its prevalence varies in different parts of Iran, therefore, it is necessary to investigate the risk factors in high risk areas and making appropriate plans to reduce the rate of cleft lip and cleft palate.

Background and purpose: This review study and meta-analysis aimed at providing evidence on helmet use and its efficacy on death and various types of head injuries caused by motorcycle crashes in different countries. Methods & Materials: Relevant databanks such as PubMed, Scopus, Web of Science, Science Direct, Embase and some relevant websites were searched for suitable studies. Two authors independently performed article selection, quality assessment and data extraction. Data analysis was done in Stata Software V14 applying random effects model. Overall, 107 studies -with different qualities- were entered into the current systematic review and 100 studies were entered into our meta-analysis. Total rate of helmet use in motorcycle riders and occupants were 63% (95%CI: 56-69%) and 41% (95%CI: 33-48), respectively. The studies that examined the effectiveness of helmet use in reducing head, face and neck injuries, (while controlling the confounders) showed that wearing helmet could reduce the risk of death by 45% (OR= 0.55, 95%CI: 0.41-0.68) and the risk of head and face injuries by 57% (OR=0.43, 95% CI: 0.36-0.50). But it was found that helmet may not considerably reduce the risk of neck injury. In spite of the efficacy of helmet use on reducing the rate of deaths and head injuries among motorcyclists after a traffic collision, its use is still low and varies in different countries. But, the findings suggest that more use of helmets can facilitate global efforts to reduce road traffic injuries.