مجله دانشگاه علوم پزشکی مازندران
پیاپی 194 (اسفند 1399)

This research aimed at investigating the effect of herbal medicine on reduction of pulmonary complications in patients with Coronavirus disease 2019 (COVID-19).

Forty patients with COVID-19 infection older than 18 years of age (60% men) with the average age of over 55 years old enrolled in this study. Written consent was obtained and participants with the following symptoms were divided into experimental group and control group: body temperature higher than 38℃, lymphocyte counts of less than 1200, positive CRP, respiratory symptoms, and pulmonary involvement in lung CT scan. The control group was treated with 400 mg Kaletra® and 200 mg hydroxychloroquine oral every 12 hours, and the experimental group, in addition to this regimen, received 5 ml of a herbal medicine (consisting of Satureja hortensis L., Hypericum perforatum L. and Foeniculum vulgare L.) three times a day. Statistical analysis was done in SPSS applying Chi-square test and t-test.

The herbal medicine was found to be significantly effective in decreasing the time of hospitalization and recovery from the disease (8.5 days in control group vs. 5 days in experimental group, (P<0.05). Also, CRP levels decreased significantly in experimental group and CRP level changes in the control group were 4.75 times higher than the experimental group (P<0.05). Furthermore, pulmonary involvement improved by 8.34% in experimental group compared to the control group (P<0.05).

The herbal drug administered in this study, considerably improved lung symptoms and decreased the course of treatment of COVID-19 infection.

Apoptosis is a protective cellular process that plays an important role in the development and homeostasis of natural tissues as well as disease-causing factors. Current study aimed at determining the effect of aerobic training, Vitamin D, and injection of adipose tissue-derived stem cells (ADSCs) on some apoptotic and anti-apoptotic indices of beta-pancreatic cells of streptozotocin (STZ) induced diabetic rats.

In an experimental study, 80rats (220-240g, 8 weeks old) were randomly divided into 10 groups: Control, Sham, diabetics, ADSCs, exercise, Vitamin D, ADSCs +exercise, ADSCs +Vitamin D, exercise+ Vitamin D, and ADSCs +exercise+ Vitamin D. The exercise protocol included treadmill running at 60-70% VO2max for 5 days a week/ 6 weeks. In ADSCs receiver groups, human ADSCs (1.5*106 PBS/5mL) were injected to the tail vein. Diabetes was induced by intraperitoneal injection of streptozotocin (60mg/kg) dissolved in citrate buffer, pH 4.5. Bax and Bcl2 values of beta pancreatic cells were measured following homogenization and centrifugation using ELISA. Data analysis was done applying one way analysis of variance and Tukey test.

Significant differences were seen between the levels of Bax and Bcl2a well as the ratio of Bcl-2/Bax between diabetic group and control group and diabetic group and other groups (P=0.001). But, there were no significant differences between other groups (P=0.001).

It seems that all interventions, especially their combination, can have an increasing effect on Bcl2 values and decrease Bax values and the ratio of beta-pancreatic cells. So, they can be used as a Bax pharmacological method to reduce hyperglycemia-induced apoptosis on beta cells.

Burn wounds are a good host for infections. Acinetobacter baumannii is an opportunistic bacterium in patients with burn infections. Toxin-antitoxin systems (TAS) are genetic elements that are essential for antibiotic resistance and biofilm formation in bacteria, including higBA and relBE TA systems. The present study aimed to investigate the frequency of higBA and relBE genes in A. baumannii strains isolated from burn wound infection as well as the association between genetic elements and antibiotic resistance and biofilm formation.

In this descriptive cross-sectional study, 139 A. baumannii isolates were collected from burn wounds of patients hospitalized in a burn center in Isfahan, Iran. The isolates were identified and confirmed through biochemical and molecular tests. Antibiotic susceptibility testing was performed via disk diffusion method and biofilm production was detected by microtiter plate assay. Presence of higBA and relBE TA system genes was investigated by PCR.

Out of 139 A. baumannii isolates, 114 were multi-drug resistant (MDR) and able to form biofilm. relBE and higBA genes were observed in 94.73% and 8.77% of the isolates, respectively. Significant correlations were found between the presence of relBE and higBA genes and resistance to imipenem and levofloxacin (P<0.05). There were no significant correlations between presence of relBE and higBA genes and biofilm formation (P>0.05).

In this study, the number of MDR A. baumanni strains was significantly higher compared to previous studies and most species had the ability to form biofilms. According to the association between TA genes and antibiotic resistance, further studies are needed on the TA systems.

Androgens play a key role in growth of ovarian follicles and female fertility in the process of in vitro fertilization. This study was performed to determine the relationship between androgen levels and success rate in Intracytoplasmic sperm injection (ICSI).

A nested case-control study was carried out in 60 infertile women attending the Infertility Treatment Center in Sari Imam Khomeini Hospital. They underwent agonist protocol and their levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), testosterone, and dehydro epiandrosterone-sulfate (DHEA-S) were measured on days three of menstrual cycle and ICSI cycle, day six of gonadotropin injection, and the day of human chorionic gonadotropin (HCG) injection. Data were analyzed in SPSS V18 applying independent T-test.

The mean age of participants was 30.1± 6.1 years. Among the subjects, 16 (26.7%) became pregnant and 44 (73.3%) did not become pregnant. On day three of ICSI cycle and before the onset of HCG injection, testosterone level was 0.88 ± 0.68 ng/ml in pregnant women and 0.53 ± 0.25 ng/ml in non-pregnant women (P= 0.012). The levels of DHEA-S were 2.79 ± 1.87 µg/l and 1.62 ± 1.45 µg/l in pregnant and non-pregnant women, respectively (P= 0.02).

Androgen levels can play a significant role in the success of ICSI cycle, so, androgen therapy can be an attractive hypothesis for improving ovarian response and used as a treatment option to increase the success of in vitro fertilization.

Ischemic stroke is one of the most common neurological diseases that leads to disability in many cases. The aim of this study was to investigate the factors affecting the duration of hospitalization in patients with ischemic stroke undergoing thrombolytic therapy.

This retrospective descriptive-analytical study was performed in consecutive adult patients with ischemic stroke who underwent thrombolytic treatment in Neurology Department of Sari Bu Ali Sina Hospital 2016-2018. Factors associated with duration of hospitalization were investigated.

The records of 173 patients (54.9% males) were studied and the mean age of patients was 68.5 ± 12.3 years. During hospitalization, pneumonia, urinary tract infection, and other infections were seen in 19.7%, 9.8%, and 1.2%, respectively. Among the patients, 12.7% experienced hemorrhagic complications. Duration of hospitalization was <7 days in 52.6% and ≥7 days in 47.4% of the patients. Length of hospitalization was significantly associated with hyperlipidemia (P=0.005), stroke severity (P=0.02), large vessel stroke (P<0.001), hemorrhagic complications (P=0.004), and nosocomial infections (P<0.001).

Hyperlipidemia, stroke severity, complications of thrombolysis, and nosocomial infections affect the length of hospital stay in patients with ischemic stroke who received alteplase. Therefore, appropriate approach is needed in management of these patients to prevent and eliminate the aforementioned factors.

The outbreak of Coronavirus Disease 2019 (COVID-19) pneumonia is a major threat to global public health because it is very contagious and spreads quickly by human-to-human transmission. This study aimed to investigate the clinical characteristics and outcome of patients infected with COVID-19 in Saveh, Iran.

A descriptive-analytical study was conducted in 1537 patients with suspected or confirmed COVID-19 from 18 February- 2 June 2020. Medical records were studied and a researcher-made questionnaire consisting of demographic information, epidemiological, and clinical manifestations were used to collect the data.

There were significant differences between patients tested positive and negative for COVID-19 in terms of gender, age, duration of hospitalization, and contact with a patient with confirmed COVID-19 (P<0.05). The main symptoms of patients included cough (43.8%), fever (41.4%), and dyspnea (40.3%). The most common chronic diseases in these patients were cardiovascular disease (12.9%), diabetes (11.5%), and hypertension (9.7%). The mean age of death due to COVID-19 was 70.2±15.6 years and higher rate of mortality was seen in men (66.2%).

While responding to COVID-19, health authorities should consider vulnerable groups (older patients and those with underlying diseases) and provide them with more information on the modes of transmission of COVID-19 and the risks of infection.

Computed tomography scan (CT) is highly capable of diagnosing abdominal and pelvic lesions. Injection of contrast media at appropriate concentration and volume provides the least side effects and the highest image quality. This study aimed at investigating the volume of contrast medium injected and the level of image contrast compared to the standard model, in the imaging department of referral hospitals in Mazandaran province, Iran.

In this quantitative descriptive study, CT scan imaging protocols in abdominal examinations and physical characteristics of the patients were recorded The difference in the volume injected of contrast media were compared between conventional method and standard method. Several CT scan images with different contrast levels were divided into four image quality groups by two experienced radiologists based on the ratio of contrast to image noise (CNR) of the organs. The percentage of adherence of the centers to the standard method and the percentage of each image quality group was calculated using descriptive statistics.

The CT scan imaging centers showed low adherence (37%) to the standard method (weight-based injection). Among the images investigated, 51.6% had excellent and good contrast levels. There was no correlation between patients’ weight and the volume of contrast medium injected (P<0.05). The CNR of the organs increased as the amount of iodine injected per unit mass increased. 

Imaging centers should select the volume of the contrast medium based on patientchr('39')s weight. The image quality is a function of the amount of iodine injected per unit weight of the patient, therefore, the concentration of contrast agent must be correctly selected.

Depression and anxiety affect the outcomes of diabetes treatment, but, it is not yet completely understood how this happens. We used a structural model to assess the relationship between depression and anxiety considering the mediating role of physical activity on treatment adherence and diabetes control.

The present study was conducted using the data of a cohort study in Kerman, Iran. Data was collected using Beck Depression Inventory, Beck Anxiety Inventory, and Global Physical Activity Questionnaire (GPAQ). Fasting blood sugar level and HbA1c levels were also measured. Diabetes was diagnosed based on medical history. Treatment outcomes included adherence to treatment and diabetes control (measured by HbA1c). Data analysis was carried out in Stata V15 applying structural analysis model.

Non-adherence to diabetes treatment was seen in 5.7% of the patients and treatment failure occurred in 67.9%. Anxiety and depression levels in the past had a significant positive correlation with HbA1c levels (β= 0.156, P= 0.032); 61% through direct effect (β= 0.096) and 39% through indirect effect via physical activity (β= 0.060). Also, the findings showed a significant positive correlation between non-adherence to treatment and current anxiety and depression levels (β= 0.093, P = 0.001); 96% through direct effect (β= 0.089) and 4% through indirect effect via physical activity (β= 0.003).

Despite optimal self-reports of adherence to treatment, about two thirds of people studied had uncontrolled diabetes. Interventions aiming at increasing physical activity can reduce the adverse effects of anxiety and depression on poor glycemic control.

One of the unique features of the Dimensional or Alternative Model of Personality Disorders (AMPD) in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), is considering personality traits in adolescence. There are many studies on the validity and structure of DSM-5’s AMPD in Western culture. The aim of this study was to investigate the AMPD in Iranian adolescents and comparing the psychometric characteristics of the original, short and brief forms of Personality Inventory for DSM-5 (PID-5).

A cross-sectional study was carried out in 404 adolescents aging 13-18 years old, including 54.4% females, living in Tehran, Iran who were selected via convenience sampling. All participants completed the paper-based forms of the PID-5, Barratt Impulsivity Scale (BIS-11), and Patient-Reported Outcomes Measurement Information System (PROMIS)–Emotional Distress—Anxiety and Depression—Short Forms.

Cronbachchr('39')s alpha coefficient in the original form of PID-5 ranged from 0.81-0.88 (disinhibition and psychoticism, respectively) for five domains. For short form it was between 0.74 and 0.86 (detachment and psychoticism, respectively) and for brief form the Cronbachchr('39')s alpha coefficient was between 0.67 and 0.76 (negative affectivity and psychoticism, respectively). There were significant correlations between personality traits and the symptoms of depression, anxiety, and impulsivity in all forms of PID-5 (P≤0.05, P≤0.01). Factor analysis confirmed the 5-factor structure of the original, short and brief forms of PID-5.

The original, short, and brief forms of PID-5 showed good reliability and validity. This supports that all three PID-5 forms can be used for various clinical and research purposes. The brief form is mainly suitable for screening, while the original and short forms can be used in investigating abnormal personality traits in adolescents.

Esthetics is a major purpose in prosthetic treatments. Choosing the right size of anterior teeth in prosthetic and edentulous patients is a major challenge for both the patient and the dentist. This study was designed to obtain approximately close ratios for selection of anterior teeth.

This descriptive-analytical study, was performed in 121 patients. Measurements were performed using Vernier Caliper in contact with the soft tissue of the face with minimal pressure. Measurements were made while patients were in an upright position and their head was in a normal position. All patients occlusion was placed in centric relation (CO), and their lips were in resting position. The average amount of three measurements was recorded as the final result. SPSS V25 was applied for statistical analysis.

There were significant positive relationships between the size of anterior teeth and the distance between the two nasal tips (P=0.037) and between two nasal tips and canine to canine distance (P=0.014).  No significant relationships were found between the size of anterior teeth and the distance between two zygomatic arches (P=0.947) and between the width of the anterior teeth and the distance between the internal and external meatus (P=0.297, P=0.952, respectively).

The average size of facial and dental parameters was found to be different between men and women. The width and height of the face and the width and height of the maxillary central teeth were higher in men than women.

The aim of this study was to determine the effect of xerostomia and hyposalivation on quality of life in patients receiving chemotherapy and evaluating unstimulated salivary flow rate in these patients.

This descriptive-analytic study was conducted in 80 cancer patients with xerostomia undergoing chemotherapy. The Health Impact Profile-14 (OHIP-14) was administered to evaluate the effect of xerostomia and hyposalivation on patients’ quality of life. Data analysis was done in SPSS V22.

The additive and simple count OHIP-14 scores were 20.66 and 3.10, respectively. Among 80 patients with xerostomia, 50 had hyposalivation (P<0.001).

Xerostomia and hyposalivation in patients undergoing chemotherapy have negative effects on oral health-related quality of life and these patients require more attention.

Hypotension is the most common serious complication during hemodialysis. The aim of this study was to evaluate the effect of cold dialysate on hemodynamic status of patients undergoing hemodialysis.

A before/after study using a quasi-experimental design was carried out in 99 patients undergoing hemodialysis attending Rasht Razi Hospital, 2019. All patients received hemodialysis using a dialysate at 37°C for three consecutive sessions and the next three sessions were performed using a cool temperature dialysate (35.5°C). Blood pressure and pulse rate were monitored in all sessions. Data were analyzed in SPSS V16 using independent t-test and paired t-test.

Systolic and diastolic blood pressure changes were significantly different between the two dialysate temperatures (P<0.001). At 35.5°C, the mean systolic/diastolic blood pressure changes were higher than at 37°C from pre-dialysis to post-dialysis. Also, pre-dialysis and post-dialysis pulse changes were significantly different between the two temperatures (P<0.001).

According to this study, cold dialysis solution can stabilize the hemodynamic status of patients during dialysis.

Hepatitis B vaccination is recommended in HBsAg-positive mothers to prevent hepatitis B in infants. Mother-to-infant transmission of HBV causes many health problems and it is important to identify HBV positive mothers. This investigation aimed at studying the prevalence of HBV and the immunogenicity of HBV vaccination in pregnant women to prevent HBV at birth in Sari, Iran.

This descriptive observational study was conducted in pregnant women attending Sari Birth Cohort (SBC) Center, 2018-2020. A total of 1018 samples were investigated for HBV serological markers by enzyme-linked immunosorbent assay (ELISA).

The prevalence of HBV was 1.57% and 46.6% (n=474) of expectant mothers had received HBV vaccine. Immunogenicity of HBV vaccination was 51.9%. HBV prevalence was found to be significantly associated with increase in age and gestational age (P= 0.009 and P= 0.005, respectively). HBV infection in women who were not immunized was significantly associated with family history of HBV and unprotected sex (P= 0.000 and P= 0.008, respectively).

Family history of HBV, maternal age, gestational age, and unprotected intercourse were the risk factors for HBV infection in pregnant women in Sari.

Improving patient safety is one of the main goals of health systems and employees need to be continuously examined for patient safety culture. The aim of this study was to assess patient safety culture in hospitals affiliated with Mazandaran University of Medical Sciences in 2020.

A descriptive-analytical study was performed in 370 employees working in public, private, and social security hospitals. The sample size was calculated using the Cochranchr('39')s formula and the subjects were selected using simple random sampling. The Hospital Survey on Patient Safety Culture (HSOPSC) consisting of 42 questions and 12 dimensions was administered. Data analysis was done applying independent t-test and one-way analysis of variance.

Among the participants, 43.47% aged 40-50 years old, 42.74% had 1-10 years of work experience, and 60.07% had shift works. The dimensions of HSOPSC with highest and lowest scores were organizational learning and continuous improvement (4.00±0.89) and hospital delivery (2.51±0.97), respectively. Almost half of participants (51.36%) had no record of any incident in the past 12 months.

Patient safety culture was moderate in hospitals studied. Hospitals are recommended to focus more on patient safety by holding training courses for transfer of patients, and establish a reporting system and encourage staff to report errors.

Self-efficacy is central to behavior, especially preventive behaviors of Coronavirus Disease 2019 (Covid-19). Identifying the factors that lead to increased self-efficacy in individuals can pave the way for necessary decisions to change the behavior of the society. This study aimed at determining the relationship between people’s self-efficacy and perceived severity and sensitivity to preventive behaviors of Covid-19 in Sari, Iran.

This descriptive-analytical study was performed in 268 patients attending certain health centers in Sari, 2020.The subjects were selected using convenience sampling. To collect the data, a researcher-made questionnaire was administered online consisting of three sections.

The mean age of the study population was 36.81±8.6 years and 17.5% of the patients were confirmed cases of Covid-19. Among the people studied, 81.3% used soap and water to disinfect their hands. There were significant correlations between self-efficacy and perceived severity (B: 0.163, CI 95%: 0.068-0.257) and perceived sensitivity (B: 0.164, CI 95%: 0.060-0.267). Perceived sensitivity and severity also predicted 10% of the variance in self-efficacy.

Perceived severity and sensitivity to Covid-19 preventative behaviors could affect people’s self-efficacy.

Volvovaginal atrophy is a common and progressive complication in menopausal women, affecting their daily life activities, sexual health, and quality of life. Hormone therapy is associated with some problems and many women prefer herbal medicine to reduce the symptoms. This systematic review aimed to explore the effect of medicinal plants on treatment of vaginal atrophy in postmenopausal women

Electronic databases, including Scopus, Pubmed, Web of Science, Science Direct, SID, Magiran and Google Scholar search engine were searched by two researchers independently. The following keywords were used in English and Persian: Herbal Medicine, Medicinal Plants, vagina, Atrophy, Postmenopausal Period, Clinical Trial, and relevant articles published until December 2020 were selected. The CONSORT 2010 checklist was used to assess the quality of studies and those with score 18 or higher entered this systematic review.

Out of 747 articles, 12 clinical trials were investigated in current review. These articles studied seven medicinal plants (chamomile, licorice, fennel, Pueraria mirifica, flaxseed, black cohosh, and red clover). Herbal products can have beneficial effects on reducing the symptoms of vaginal atrophy in postmenopausal women.

Medicinal plants containing phytoestrogens can be considered as a treatment of choice for improving vaginal atrophy and a suitable alternative to chemical drugs following further studies that prove their efficacy.

There are various factors affecting mother’s feelings, pain, and excitement during pregnancy which play significant roles in making decision about terminating pregnancy and reducing its outcomes. This study aimed to systematically review the effect of hypnosis on pregnancy and childbirth outcomes.

In this systematic review, we thoroughly searched Google Scholar, PubMed, Web of Science, Scientific Information Database (SID), Cochrane Library, Scopus, Magiran, Registry of Clinical Trial (IRCT), and ProQuest with no time limitations. After removing unrelated studies, 21 English articles were included. The quality of these articles was determined by Jadad Scale. Finally, 13 studies entered into our meta-analysis. To assess the heterogeneity, Q and I2 tests were used and STATA 11 was used for data analysis.

According to the findings, the effects of hypnosis on pregnancy and delivery outcomes were classified into six categories as the following: hypnosis decreases the consumption of pain relief medicines (OR=0.21, CI95%: 0.12- 0.38, P<0.001), it does not decrease the consumption of oxytocin (P=0.880), it does not decrease the rate of Cesarean section (P=0.082), it leads to higher rates of natural vaginal delivery (OR=3.06, CI95%:1.75-5.32, P<0.001), it does not decrease the rate of preterm labor (P=0.051), and it does not increase neonatal Apgar score (P=0.27). 

Hypnosis interventions can reduce the consumption of pain relief medicines, and also increase the rate of normal vaginal delivery.

The ultimate goal in periodontal treatment is to achieve a functional and anatomical regeneration of lost tissues. Due to the promising outcomes of biologic modifiers in regenerative therapies, this systematic review aimed at evaluating the effects of various biologic modifiers used in intra-bony osseous defects in animal models.

Electronic databases were searched for articles published in March 2010-March 2020 that had evaluated the effect of bio-modifiers used in periodontal intra-bony osseous defects in animal models. Screening was performed based on inclusion/exclusion criteria and SYRCLE tool was used for studies’ quality assessment.

After screening the titles, abstracts, and full-texts, 18 studies were included in qualitative analysis and five studies entered the meta-analysis. According to the configuration of osseous defects, the studies were categorized into three subgroups. Based on histological findings, all these biologic markers significantly enhanced new bone and cementum formation compared to control groups (P<0.001). The meta-analysis showed that biologic modifiers could significantly increase bone regeneration
(1.58 mm, 95% CI: 1.12-2.03, P˂0.001) and cementum regeneration (1.27 mm, 95% CI: 0.84-1.70, P˂0.001) in one-wall osseous defects.

Biologic modifiers namely growth factors could positively affect periodontal regeneration, particularly the cementum and bone in animal models. Further human studies are necessary to address the clinical use of these biomaterials.

Inflammatory rheumatic diseases, in addition to involvement of the joints and different systems, are associated with increased risk of morbidity and mortality. One of the most common causes of death in patients with these diseases is cardiovascular causes which can be due to the nature and pathophysiology of the disease, chronic inflammation, and the drugs used. Despite different pathogenesis and symptoms of rheumatoid arthritis, systemic lupus erythematosus, psoriatic arthritis, and gout, the presence of chronic inflammation is a common pathophysiological feature in these diseases. Metabolic syndrome is reported to be associated with some of these conditions. The study of metabolic syndrome in inflammatory rheumatic diseases is important from different perspectives, since it plays a role in development of cardiovascular disease and pro-inflammatory status and also influences the choice of treatment and related monitoring. Here, first, the importance of metabolic syndrome in rheumatic diseases in general is discussed, then each of the above diseases is evaluated separately. It seems that abdominal obesity in patients with rheumatoid arthritis and lupus, and hypertension and obesity in patients with psoriatic arthritis, and hypertriglyceridemia and hypertension in gout are important components of metabolic syndrome that require more care.

In many universities, the physical presence of dental students is required to learn the theoretical sciences and clinical skills. These students are at a high risk to get infected with Coronavirus disease 2019 (COVID-19) because aerosol production and close contact with patients is inevitable. In this review study, the challenges in educating dental students during the COVID-19 pandemic and related solutions are discussed.

MEDLINE, Scopus, Ovid, and Google scholar databases were searched for relevant articles published in English until September 7, 2020. Articles with the target population of specialty/general dentistry students were included and studies associated with graduate dentists or other pandemics were excluded. After quality assessment, 49 studies were included in current review.

The COVID-19 pandemic caused disruption in traditional face-to-face dental education which was replaced by synchronous learning. This type of learning is faced with some challenges, including lack of sufficient facilities and lack of familiarity of involved people. In this situation, teaching and assessment of theoretical modules should continue virtually with high quality. Clinical units should also be organized by grouping students in smaller numbers and more shifts while adhering to new infection control protocols. Research can also be continued on animal models and COVID-19-related subjects.

Improving the structure of theoretical and clinical education in dentistry is recommended to deal with similar crises in the future.