مجله دانشگاه علوم پزشکی بابل
سال بیست و سوم شماره 1 (پیاپی 138، فروردین 1400)

Ketogenic diet (KGD) is a low-carbohydrate, high-fat and average protein dietary formulation, which has been reported with the ability to ameliorate several metabolic diseases, especially those under the direct influence of hormonal disruptions. Monosodium glutamate (MSG) had been found to induce uterine fibroids in laboratory animals through alterations to hormones, lipids and oxidative state. The present study was conducted to evaluate the effect of KGD on MSG-induced uterine fibroid.

In this experimental study twenty-four female Wistar rats were divided into four groups of six. Control group received distilled water while the remaining groups were given 300 mg/kg body weight of MSG once a day for 28 days. Thereafter, the three groups of MSG, MSG + keto group 1 and MSG + keto group 2 received standard rat chow, cabbage-based ketogenic diet and coconut-based ketogenic diet, respectively for 42 days. Estrogen, Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), malondialdehyde (MDA), Superoxide Dismutase (SOD), catalase (CAT), and Total Cholesterol (TC) were determined in the blood of animals using standard methods and induction of fibroids was confirmed in the uterus by histomorphological measurements.

Significant elevations (p<0.05) were observed in the levels of estrogen (1.80±0.09 &1.27±0.12), LH (1.04±0.04 & 0.39±0.01), FSH (1.51±0.04 & 0.65±0.03), TC and MDA in the MSG group compared to control. There were significant decreases (p<0.05) in the activities of CAT and SOD enzymes in the MSG group compared to control. Histological analysis confirmed significant reduction (p<0.05) in leiomyomas of the dietary treatment groups compared to that of MSG.

The study suggests that cabbage- and coconut-based KGD may control the occurrence and progression of fibroids through reduction of oxidative damage and amelioration of hormonal imbalance induced by MSG.

Ribes khorassanicum has beneficial cardiovascular effects in normotensive and hypertensive animals. For further investigation, the effect of three fractions of aqueous (polar), ethyl acetate (polar and non-polar) and n-hexane (non-polar) of the plant s hydroalcoholic extract on cardiovascular parameters in normotensive rats was compared with its total extract.

In this experimental study, 42 rats were divided into 7 groups (6 in each group): control, three doses of total extract 4, 12 and 24 mg/kg and three fractions of aqueous, ethyl acetate and n-hexane (20 mg/kg). Femoral artery cannulation and heart rate (HR), mean arterial pressure (MAP) and systolic blood pressure (SBP) were recorded throughout the experiment and then the changes (Δ: difference before and after injection) were calculated and statistically analyzed.

24 mg/kg of the extract significantly increased ΔHR (117.5±11.6 beats per minute) compared to control (5.3±2.7, p<0.001) and 12 mg/kg of the extract significantly decreased ΔMAP (-15.1±2.8 mm Hg) and ΔSBP (-18.4±3 mm Hg) compared to the control (p<0.05). The fractions increased ΔHR, which was not significant but was significant compared to 24 mg/kg of the extract (p<0.05). Furthermore, the increase of ΔMAP and ΔSBP in n-hexane fraction (19.45±3.1 mm Hg and 34.6±11.5 mm Hg, respectively) was significant compared to the control and 12 mg/kg of the extract (p<0.01 to p<0.05).

The active ingredients in the cardiovascular effects of Ribes khorassanicum extract are spread in all fractions and the total extract has a better effect than each of the fractions alone due to its various non-polar and polar compounds as well as the synergistic effect.

Glioblastoma is a highly malignant brain tumor that is characterized by poor prognosis and high recurrence rate in patients. Surgery, chemotherapy and radiotherapy are considered as standard methods of glioblastoma treatment. However, these methods have not been able to completely kill cancer cells. One of the most important barriers to the treatment of glioblastoma is the blood-brain barrier, which prevents drugs from reaching the brain tissue. The aim of this study was to investigate the possibility of using exosomes as drug carriers in the treatment of glioblastoma tumor.

In this review article, we searched Google Scholar and Pub Med databases using the keyword “exosomes”, “glioblastomas”, and “drug delivery systems” to provide an overview of exosomes as an opportunity for the delivery of drug into the central nervous system through the blood-brain barrier.

In the initial search, 14400 articles were found, and after an initial review and removal of unrelated studies, 40 articles were finally reviewed. Exosomes are natural nanoparticles that are secreted from different cells. Using exosomes in drug delivery systems is an efficient approach for transferring various contents to cancer cells. These particles are also able to transfer biological and drug molecules from the blood-brain barrier to brain cells. These natural nanoparticles are stable with long circulations that do not cause immune rejection responses.

According to the results of this study, as a potential carrier with very interesting and attractive advantages in drug delivery and transfer of drug agents, exosome-based nanocarriers can be used to treat brain tumors such as glioblastoma multiforme.

Cerclage surgeries for the treatment of cervical insufficiency are performed transvaginally. However, in some patients, due to anatomical changes of the cervix caused by congenital factors or previous surgery, they cannot be performed transvaginally. Transabdominal cervicoisthmic cerclage (TCIC) is considered in these cases. The aim of the present study was to report the results of three successful cases of transabdominal cerclage.

CASE REPORT: 

The first patient was a 34-year-old woman with a history of failed curettage and transvaginal cerclage. By the seventh week of pregnancy, the patient underwent transabdominal cerclage via laparotomy due to the possibility of preterm delivery and cervical insufficiency. The next patient was a 40-year-old woman with a history of performing six IVF sessions and having two live fetuses, underwent TCIC laparotomy at 13th week of pregnancy due to the possibility of preterm delivery and cervical insufficiency. Another patient was a 24-year-old woman with a history of transvaginal curettage and cerclage and 2 miscarriages. This patient also underwent laparoscopic TCIC surgery due to the possibility of preterm delivery and cervical insufficiency. All three patients underwent cesarean section at 38th week of gestation and gave birth to healthy babies.

According to the present study, transabdominal cerclage via laparoscopy or laparotomy in patients with preterm delivery or cervical insufficiency has favorable results in women with unsuccessful transvaginal cerclage.

Maternal mental health is one of the factors affecting the development of the child, especially in the early years of life. Since lack of attention to development of infants and the following complications may lead to irreparable consequences, this study was performed to investigate the relationship between maternal mental health and the development of infants under one year of age.

This cross-sectional study was performed on 200 mothers with infants aged 12 months who referred to Babol health centers in 2018. The required data were collected using demographic questionnaire, Goldberg General Health Questionnaire (GHQ-28) (score 21 and below means health and 22 and above means disorder) and the Spielberger State-Trait Anxiety Inventory (STAI) (scores between 20-34 are minimum, 35-45 mild, 46-54 average and greater than or equal to 57 are defined as severe).

The mean age of mothers in this study was 29.8±5.13 years. 29% of mothers had symptoms of mental disorder. The mean score of maternal general health was 19.20±11.89 and the mean score of the depression component was 2.45±3.62. In Spielberger State-Trait Anxiety Inventory, there was a difference in infant weight index between growth percentiles of 15-50% and 50-85% at birth (p=0.015). However, no significant difference was observed with the growth process. Goldberg General Health Questionnaire (GHQ-28) did not show a significant relationship with infants weight, height and head circumference at the end of one year. All infants had a normal growth pattern in all three indices of weight, height and head circumference.

The results showed that there is a relationship between maternal mental health and infant birth weight. But in the growth process, there is no relationship between infants growth indicators and mothers mental health.

The rabies virus infection leads to 60,000 deaths worldwide each year and is considered an economic and social hazard. Although our knowledge of the rabies virus replication and its interaction with the host cell is in its infancy, it helps us design optimal drugs and vaccines. Therefore, the aim of this study was to evaluate the changes in catalase and superoxide dismutase (SOD) enzymes, nitric oxide (NO) chemical composition and NF-κB gene activity as biomarkers of oxidative stress response in brain tissue of mice infected with street rabies virus.

In this experimental study, 16 21-day-old outbred mice were divided into two groups of healthy and experimental (n=8). After determining the titer of rabies virus, the mice in the experimental group received 0.03 ml of rabies virus with LD50 intracerebrally (IC) using Hamilton 0.25 ml syringe. To evaluate the changes of catalase, NO, and SOD enzymes, test kit and colorimetric method were used and NF-kB activity was evaluated by Real-Time PCR according to Sdha gene.

In this study, catalase activity in the brains of infected mice (0.14±0.007) was significantly reduced compared to healthy mice (control) (0.67±0.008) (p=0.01). In this experimental study, the SOD activity in the brains of infected mice (3±0.2 nmol/min/ml) was significantly reduced compared to healthy mice (control) (5.7 nmol/min/ml) (p=0.035). Evaluation of NO accumulation in the brain tissue of the infected group (9.0±0.04 mU/mg) was significantly increased compared to the healthy group (9.04±0.03 mU/mg) (p=0.025). Furthermore, the expression level of NF-κB in the brain of the mice infected with rabies virus was one tenth of the expression of this gene in the brain of healthy mice.

The results showed that rabies virus decreased the activity of catalase and SOD enzymes and increased nitric oxide. Furthermore, NF-κB expression decreased in the brain of mice infected with rabies virus, which may be due to the effect of the virus on the cellular signaling pathway.

Neuroticism and extroversion have a high and positive relationship with psychological problems such as anxiety and depression. Since cardiovascular diseases are also considered as psychotic that can be reduced by modifying lifestyles and changing high risk behaviors this study was conducted to compare the effectiveness of emotional schema therapy on neuroticism and lifestyle of cardiovascular patients.

This cross-sectional study was performed on 30 patients with cardiovascular disease referred to Rouhani Hospital in Babol who were randomly divided into two groups of emotional schema therapy and control. The emotional schema therapy protocol was performed during 12 weekly sessions of 2 hours. Using NEO-FFI (score 12-60) and Health Promoting Lifestyle (HPLPII) questionnaires (score 48-192), before the intervention, after the intervention and one month later, the two groups were evaluated and compared.

There was no significant difference between the two groups in terms of age and sex. The mean scores of neuroticism before and after the intervention in the control group were 38.93±7.31 and 37.80±4.63, respectively, and in the emotional schema therapy group were 37.73±6.94 and 32.53±6.75, respectively. The mean score of promoter lifestyle in emotional schema therapy group before and after the intervention was 113.13±28.25 and 138±32.27, respectively (p<0.05). Implementation of emotional schema therapy had a significant effect on Neuroticism (6.95, 0.014 and 0.205) and lifestyle (11.67, 0.002 and 0.302) and led to the reduction of Neuroticism and the promotion of lifestyle.

The results of this study showed that emotional schema therapy can be an effective intervention in reducing neuroticism and promoting lifestyle in cardiovascular patients.

The hamstring muscle is one of the muscles with a high risk of injury due to loss of flexibility. Using deep heat modalities is one way to improve muscle flexibility. Given that TECAR therapy is a new way to produce heat in deep tissues, the present study was conducted to compare the short-term effects of TECAR therapy and static stretching on hamstring flexibility in athletes.

This single-blinded randomized clinical trial was performed on 20 male athletes. Samples were randomly divided into two groups of TECAR therapy with static stretching (n=10) and static stretching (n=10) and were treated for three sessions. Active knee extension (AKE) test, passive knee extension (PKE) test, and sit and reach test were performed before treatment, after the first session and after the third session.

The mean values of active knee extension and passive knee extension (degree) and mean values of sit and reach test (cm) after the third session in the TECAR therapy group were 72.10±1.59 and 71±1.49 and 35.20±2.39, respectively, and in the static stretching group were 70.70±1.49, 69.70±1.05 and 34.80±1.61, respectively. The results of this study showed that in both groups, the range of active knee extension (p<0.0001), the range of passive knee extension (p=0.004), and the range of motion in sit and reach test (p=0.004) improved significantly after the first and third sessions. The improvement of all three flexibility indices in the TECAR therapy group was higher than static stretching, but there was no statistically significant difference between the two groups.

The present study showed that TECAR therapy with static stretching causes a greater increase in hamstring flexibility than static stretching alone.

CD10 is a zinc-dependent metalloproteinase that is associated with factors influencing the prognosis of some cancers. Prostatic adenocarcinoma is one of the most common cancers in men and Gleason grading is an important factor in its prognosis. The present study was conducted to investigate the relationship between immunohistochemical expression of CD10 and Gleason score as an indicator of prognosis in prostatic adenocarcinoma.

In this cross-sectional study, 60 paraffin blocks of prostatic adenocarcinoma samples from patients referred to Shahid Mostafa Khomeini Hospital in Tehran from 2013 to 2017 were immunohistochemically stained according to CD10 marker. Information about Gleason score was obtained by observing stained slides by hematoxylin and eosin staining method. The percentage of CD10 positive tumor cells was determined by primary and secondary Gleason score and the relationship between CD10 expression and Gleason score was evaluated.

The mean age of patients was 71±8.79 years. The percentage of CD10 expression varied from 5% to 62% in different samples. The mean percentages of CD10 expression in tumor cells in primary Gleason scores 2 to 5 were 10.75%, 16.16%, 35.20% and 44%, respectively and in secondary Gleason scores 2 to 5 were 10.38%, 17.08%, 38.19% and 53.5%, respectively (p<0.001).

According to the results of this study, the immunohistochemical marker CD10 has a variable expression in prostatic adenocarcinoma and its increased expression is associated with an increase in the microscopic Gleason score of tumor as a factor influencing the prognosis.

Induction of anesthesia and surgery lead to metabolic changes and make it difficult for diabetic patients to control their blood sugar. Complications of kidney failure may also affect the management of anesthesia in these people. The present study was conducted to report three cases of anesthesia in patients undergoing simultaneous kidney-pancreas transplantation.

CASE REPORTS: 

The first patient was a 33-year-old woman, the second patient was a 28-year-old woman, and the third patient was a 27-year-old woman, all of whom had diabetes mellitus and diabetic nephropathy and were under hemodialysis treatment. All patients underwent general anesthesia. Drugs used for anesthesia included midazolam, fentanyl, cisatracurium, and propofol. All patients underwent simultaneous kidney-pancreas transplantation. Postoperative condition of transplanted patients was favorable and they are still under the supervision of a physician.

Based on the results of this study, good management of anesthesia and the use of appropriate anesthetic drugs and control of hemodynamic conditions and pain management can improve the outcome of kidney-pancreas transplantation.

Jaundice (hyperbilirubinemia) is one of the most common clinical complaints during infancy among term and premature infants during the first week of life. Phototherapy is an effective and accepted treatment for neonatal hyperbilirubinemia, which may be associated with complications such as skin, eye and electrolyte disorders. This study was performed to compare the effect of phototherapy with oral calcium versus phototherapy alone in the treatment of unconjugated hyperbilirubinemia in healthy term infants.

This clinical trial study was performed on 50 healthy term infants with jaundice (serum bilirubin 6.9-21 mg/dL). Neonates were randomly divided into intervention (50 mg/kg body weight of oral calcium with phototherapy) and control (phototherapy) groups. Data related to age, gender, birth weight, gestational age, number of hospitalization days and bilirubin level at the beginning of hospitalization and at 24, 48 and 72 hours were collected and compared in a checklist.

Decrease in total bilirubin level was observed with a significant difference between the two groups (p=0.000). The mean unconjugated hyperbilirubinemia showed significant difference in the intervention group (2.1±0.5 mg/dl) and the control group (2.6±1.3 mg/dl) (p=0.03). The changes in unconjugated hyperbilirubinemia in repeated measures was also significant in the intervention group (p=0.01).

The results of the study showed that oral calcium with phototherapy may be effective in reducing neonatal jaundice.

Prenatal care is an important strategy for achieving reproductive health. Despite the importance of maternity care in maternal health, some mothers are not adequately cared for. The aim of this study was to determine the factors affecting the Adequacy of Prenatal Care Utilization (APNCU) Index in the first level of network system in Iran.

This cross-sectional study was conducted in six provinces of Iran in 2016. Mothers whose date of delivery was 2-6 months before the study were randomly selected. Data were collected using a researcher-made checklist and questionnaire containing 34 personal, family-related and environmental questions and 23 prenatal care-related questions based on health records and interviews with mothers and samples were divided into four groups according to the Adequacy of Prenatal Care Utilization index: 1: inadequate (less than 50% of expected care), 2: intermediate (50-79%), 3: adequate (80-109%), 4: adequate plus (110% and more), and the results were analyzed.

Among 2655 studied mothers, the mean of total care during pregnancy was 6.43±1.7 times and according to the Adequacy of Prenatal Care Utilization index, 121 (4.6%) mothers had inadequate care, 603 (22.7%) mothers had intermediate, 1648 (62.1%) mothers had adequate and 283 (10.7%) mothers had adequate plus care. There was a significant relationship between the risk of maternal mortality in each province, urban population, prenatal care, time of first pregnancy care, maternal age, spouse s participation and education level, and adequacy of prenatal care (p<0.05).

This study showed that the adequacy of prenatal care, although influenced by social and personal factors, is at an appropriate level.

Considering various applications of alcohol in human life in today s world, it is important to discuss whether alcohol is pure (Tahir) or impure (Najis). The present study was conducted to investigate its jurisprudential aspects from the viewpoint of Shiite Islam (one of the two main branches of Islam).

This study was designed based on library collection development method as well as methods of reasoning by reviewing texts published on purity (Taharat) and impurity (Najasat) of alcohol and any intoxicating liquor. Qur anic verses, formal legal opinions of religious scholars (Fatwas) and narrations (Hadiths= Record of the traditions or sayings of the Prophet Muhammad) were used here.

There is disagreement between the jurists (Faqīhs) about the purity of alcohol. The argument of the jurists who believe in the impurity of alcohol is based on the fact that alcohol is an intoxicating liquor and that anything that is intoxicating is impure, and as a result alcohol is impure. In this study, both introductions of this argumentation are questioned by a careful examination of the narrations (Hadiths) and arguments (Dalil). That is, the arguments for the impurity of any intoxicating liquor has been criticized and if we assume that any intoxicating liquor is impure, it has been proved that alcohol is not considered an intoxicating factor.

The results of this study show that there is no reason for the impurity of alcohol, and we can rely on the formal legal opinions of religious scholars (Fatwas) about the purity or impurity of alcohol based on the principle of purity (Everything is purie until its impurity is proved).

Caring for hospitalized premature infants, who are exposed to a variety of painful caregiving, exposes mothers to many challenges that lead to anxiety. This study was designed to provide solutions to reduce maternal anxiety and neonatal pain.

This clinical trial was performed on 90 mothers with preterm infants in three groups of massage intervention, kangaroo care and control group. The interventions of both groups were performed from the time of stabilization of the neonates to the time of discharge from the neonatal intensive care unit. Spielberger overt and covert anxiety questionnaires with a minimum score of 20 and a maximum of 80 were completed before and after the intervention.

There was a significant difference between the levels of overt and covert anxiety of mothers in the massage group (34.43±11.74 and 32.13±9.25) and the kangaroo care group (36.90±10.06 and 38.07±13.10) compared to the control group (57.47±10.86 and 50.10±9.19) (p<0.001). This difference in the levels of neonatal pain was also significant in the massage group (1.87±1.20) and in the kangaroo care group (2.00±1.02) compared with the control group (4.17±1.21) (p<0.001).

The results of the present study showed that infant massage and kangaroo care by the mother are effective in reducing maternal anxiety as well as reducing pain levels in preterm infants.

Fatty liver disease is the most common chronic liver disorder, which is introduced as part of the metabolic syndrome. On the other hand, androgenetic alopecia in men, which is the most common cause of hair loss, can also be associated with cardiovascular disease and metabolic disorders. Due to the common risk factors for fatty liver and androgenetic alopecia, this study was performed to compare the frequency of fatty liver in men with and without androgenetic alopecia.

In this cross-sectional study, 140 men aged 25 to 55 years (70 men in two groups of men with and without androgenetic alopecia), who referred to the dermatology clinic for cosmetic reasons, volunteered to participate in the study. Age, body mass index, abdominal circumference, smoking history, extent of hair loss and liver ultrasound results were evaluated and compared in the two groups.

The mean age of participants was 35.84±7.90 years. There was no statistically significant difference between the two groups in terms of age, smoking, and abdominal circumference. 54 men with androgenetic alopecia (77.1%) had fatty liver, while 41 people in the group without androgenetic alopecia (58.6%) had fatty liver, which showed a significant difference (p=0.019). Grade one and three fatty liver was significantly higher in patients with androgenetic alopecia compared to the group without androgenetic alopecia (p=0.011). There was no statistically significant relationship between the grade of fatty liver and the extent of androgenetic alopecia (p=0.059), but the extent of hair loss in obese individuals was significantly higher (p<0.001).

According to the findings of this study, fatty liver disease has a significant frequency in men with androgenetic alopecia.

Agenesis and hypoplasia of the paranasal sinuses is an anatomical variation that often occurs in frontal sinuses but this rarely happens combined with other paranasal sinuses. The present study was conducted to report a rare case of hypoplasia of the paranasal sinuses and atrophy of all three turbinates in Iran.

CASE REPORT:

 In this study, we report the case of a 28-year-old man who referred with trauma to the head and anosmia. The patient had no complaints of nasal obstruction or congestion, cerebrospinal fluid leakage before or after trauma. He also had no previous history of rhinosinusitis or olfactory disorder. CT scans of nose and paranasal sinuses showed some findings such as bilateral middle and inferior concha atrophy, bilateral hypoplasia of maxillary, ethmoid, sphenoid, and right frontal sinuses and left frontal sinus aplasia. To the best of our knowledge, the number of reports about the combination of abnormal variations of paranasal sinuses was less than 5 and in the present case report, all sinuses had hypoplasia and at the same time, there was turbinate atrophy, while the patient had no clinical symptoms.

According to the present study, pneumatization of sinus is not necessarily associated with clinical symptoms and other factors play a role in sinus function.

Hydatid kidney and muscle involvement without liver and lung infection is very rare in children. Hydatid kidney disease can occur as cystic or even solid mass which has a differential diagnosis with a renal cystic tumor. The aim of this rare case report was to investigate the diagnostic and therapeutic pitfall of hydatid renal cyst in endemic areas.

CASE REPORT:

 This is a very rare case in an 11-year-old girl with past history of thigh muscle hydatid cyst 2 years ago who referred with vague abdominal pain. Serologic tests were negative and complex cystic mass with thickened irregular walls with vascularity and relative enhancement in the secretary phase were reported in computerized tomography (CT) scan, without involvement of any organs. Extra-peritoneal nephrectomy was performed with possible diagnosis of renal cystic tumor and final diagnosis was hydatid cyst. Ultrasonography, chest X ray and indirect hemagglutination test were performed and no evidence of recurrence or new infection was observed during one year follow up.

Considering the introduced case, in patients with complex renal cysts, in addition to considering renal cystic tumors, renal hydatid cysts should be considered in differential diagnosis in endemic areas, even if serological and radiological evaluations are not confirmatory. Furthermore, if surgery is required, it is better to consider extraperitoneal incision.

Acute endophthalmitis is one of the most dangerous complications after eye surgeries. Knowing the severity of this complication is critical for treatment policy in ophthalmology departments. The aim of this study was to determine the incidence of this complication and its prognosis in cataract surgery and intravitreal Avastin injection.

This retrospective study was performed on patients who developed acute endophthalmitis following cataract surgery and intravitreal injection of Avastin in 2011-2018. Incidence, treatment method and visual acuity of patients were compared based on the logMAR unit (minimum angle of resolution) at referral and at the end of treatment.

The incidence of acute endophthalmitis following cataract surgery in this study was 0.058% (20 cases of 34297 surgeries) with 95% confidence interval (0.032-0.083) and after intravitreal injection of Avastin was 0.042% (14 cases of 33273 injections) with 95% confidence interval (0.021-0.063). The mean age of the first group was 68.3±3.3 years and in the second group was 66.3±2.4 years. The mean final visual acuity of patients in the cataract group was 1.73±0.91 logMAR and in the intravitreal injection group was 1.61±0.87 logMAR, which was not statistically different between the two groups. Deep vitrectomy was performed in 35% of patients in the cataract group and 45% of patients in intravitreal Avastin injection group, but there was no significant difference between the two groups.

The results of the study showed that the incidence of acute endophthalmitis following cataract surgery and intravitreal injection of Avastin showed no significant correlation.

Lipoid congenital adrenal hyperplasia (LCAH) is the most severe form of adrenal hyperplasia and mutations in the StAR gene are the most common cause of the disease. Adrenal insufficiency and cholestasis are reported in few patients. The aim of this study was to report the results of treatment of two sisters with lipoid CAH and cholestatic jaundice.

CASE REPORTS: 

Here, we present two sisters at the age of 30 and 60 days with conjugated hyperbilirubinemia and elevated liver enzymes and adrenal insufficiency. They had a 46,XY karyotype with external female genitalia without uterus and ovaries. LCAH was detected through electrolyte abnormalities, increased ACTH, decreased levels of cortisol and sex hormones and was confirmed by determination of exome sequencing and Sanger sequencing. In these patients, a homozygous mutation (c.653C>T) in exon 6 of STAR gene was identified. The patients were treated with 10 mg of hydrocortisone IV every 8 hours for 3 days; oral hydrocortisone was then administered at a dose of 2.5 mg every 8 hours and 0.2 mg fludrocortisone daily. One month after the therapy, levels of bilirubin and liver enzymes of these patients became normal. The first patient died 7 months after her mother stopped giving the drugs to the child. The other patient is now 9 years old. She is in good clinical condition as her treatment goes on.

Considering the reported cases, adrenal lipoid hyperplasia should be considered as a rare cause of cholestasis with adrenal insufficiency in patients.

Head and neck trauma and related injuries account for a high rate of mortality and neurological defects. Since maxillofacial trauma occurs alone or in combination with other severe injuries, this study was performed to determine the frequency of maxillofacial fractures in patients with head and neck trauma referred to Shahid Beheshti Hospital in Babol.

This cross-sectional study was performed among all patients with maxillofacial trauma who referred to the Oral and Maxillofacial Surgery Center of Shahid Beheshti Hospital in Babol in 2018-2019. Necessary information was collected via history, clinical examinations, facial radiographs and hospital records. CT scan was performed in patients with decreased level of consciousness, neurological symptoms or clinical signs of skull fracture. Data about age, gender, cause of injury, pattern of facial or head injuries, loss of consciousness and GCS score were recorded in the questionnaire and evaluated.

The mean age of patients was 30.55±15.82 years. 44 patients (18.6%) were female and 192 patients (81.4%) were male. Out of 236 patients with head and neck trauma, the rate of upper face, midface, and lower face fractures were 3.4, 53.5 and 29.6%, respectively. The most common areas that were fractured were the Condyle (7.8%) and the Angle (7.3%) of the mandible.

The results showed that in maxillofacial fractures, the most commonly damaged area is the midfacial area.

Chronic kidney disease is one of the major health problems in todaychr('39')s world that creates a threatening situation for the health and socioeconomic status of the affected person, his/her family and the whole society. Due to the fact that in chronic diseases, a spiritual crisis appears in the individual, this study was therefore conducted to investigate the effect of spiritual health on resilience in patients undergoing hemodialysis.

This cross-sectional study was performed on 130 patients undergoing hemodialysis in Shahid Beheshti Hospital in Babol in 2017-2018. Data were collected and analyzed using Spiritual Well Being Scale (SWBS) (Paloutzian & Ellison) with a score of 20-125 at three levels of low, medium and high, as well as Connor-Davidson Resilience scale (CD-RISC) with a score of 20-125 at three levels of low, medium and high.

In this study, 5 (3.8%) patients had low, 81 (62.3%) had medium and 44 (33.8%) had high spiritual health. The mean score of spiritual health was 87.80±21.12 and was at a medium level. Furthermore, 6 patients (4.6%) had low resilience, 95 patients (73.1%) had medium and 29 patients (22.3%) had high resilience. The mean total resilience score was 86.63±19.48 and was at a medium level. The relationship between spiritual health and resilience was direct and significant (p<0.001, r=0.62).

The present study showed that spiritual health has a significant and positive relationship with resilience of patients undergoing hemodialysis treatment.

Spontaneous abortion is a psychologically devastating experience for women. Due to the high prevalence and psychological complications of abortion and the effective role of midwives in women s psychological support, this study was conducted to determine the effect of problem-solving group counseling on women s mental health after spontaneous abortion.

This clinical trial was performed in 2019 on 46 women who experienced spontaneous abortion in their first pregnancy in Imam Khomeini and Razi hospitals in Ahvaz. Subjects were randomly divided into two groups of experimental and control (23 women in each group). In the pre-test stage, the two groups completed the mental health questionnaire with a score of 0-84 and demographic characteristics. The experimental group underwent 90-minute weekly counseling sessions based on problem-solving therapy for 8 weeks. Both groups completed the questionnaire again after the intervention and one month later during follow-up.

The mean age of the experimental group was 27.95±3.92 and the control group was 28.04±3.78. Before the test, the mean score of mental health was 59.25±3.56 in the experimental group and 58.14±4.86 in the control group, indicating no statistically significant difference between the two groups. However, in the post-test stage, there was a significant difference in terms of mental health (38.45±3.03 in the experimental group vs. 58.95±4.87 in the control group) (p<0.001).

The results of the study showed that problem-solving therapy can be effective in improving the mental health of women after spontaneous abortion.

C-Myc plays a very important role in controlling cell proliferation, apoptosis and differentiation. Due to the involvement of c-Myc in the regulation of a wide range of intracellular functions and based on its role in the pathogenesis of acute promyelocytic leukemia (APL), the present study was conducted to investigate the anti-leukemia effect of 10058-F4, as a known c-Myc inhibitor, on APL-derived HL-60 cells.

In this experimental study, to evaluate the cytotoxic effects of 10058-F4 in acute promyelocytic leukemia, HL-60 cell line (prepared from Pasteur Institute of Iran) was treated with different doses of inhibitor (50, 100, 150 and 200 μM) and then in 24 -and 36- hours intervals, survival rate, cell count, metabolic activity and induction of apoptosis were respectively evaluated. In addition, transcriptional changes of apoptosis-related genes were studied by real-time PCR to investigate the molecular mechanisms of function of 10058-F4.

The results showed that inhibition of c-Myc by 10058-F4 at doses of 150 and 200 μM in 24 hours reduced the growth of HL-60 cells by 38±4% and 49±3.2%, respectively, compared to the control group (p<0.05). In addition, the cytotoxic effects of the drug are due to the arrest of cells in the G1 phase and the induction of apoptosis; Because the percentage of cells stained with Annexin V/PI in cells treated at a dose of 100 μM after 24 hours increased by 31% compared to the control group (p<0.05).

In this study, the efficacy of 10058-F4 in HL-60 cells was fully established.

Examination of bile ducts and pancreas by magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are two methods in the diagnosis of biliary tract diseases. Since ERCP is more invasive than MRCP, this study was performed to evaluate the diagnostic value of MRCP compared to ERCP.

This cross-sectional study was performed on 130 patients over 18 years of age who were suspected of common bile duct stone, also known as choledocholithiasis, based on tests and clinical examinations. MRCP was performed first and then ERCP was performed and the results of these two methods were compared.

The mean age of the subjects was 59.6±13.7 years. 53 were male (40.8%) and 77 were female (59.2%). Stone was reported with MRCP in 91 patients (70%) and ERCP in 96 patients (73.8%). The sensitivity of MRCP in the diagnosis of common bile duct stones compared to ERCP was 88.5% while the the specificity, positive predictive value, negative predictive value and diagnostic value of MRCP in the diagnosis of common bile duct stones compared to ERCP were 82.3%, 93.4%, 71.7%, 86.1%, respectively.

The results of the study showed that MRCP has a high diagnostic power in the diagnosis of common bile duct stones. Therefore, it can be used as a primary method to detect the presence or absence of common bile duct stones.

Damage to the endotracheal tube cuff during general anesthesia can cause ventilatory failure for the patient. The aim of this study is to report structural defect and herniation of the endotracheal tube cuff in a patient undergoing lumbar discectomy in the prone position.

CASE REPORT: 

The patient was a 77-year-old woman who was a candidate for Lumbar discectomy who referred to Kowsar Hospital in Sanandaj for surgery. The patient underwent general anesthesia with a spiral endotracheal tube in the prone position. After 30 minutes of surgery, there were symptoms of increased airway pressure, decreased saturation, and increased carbon dioxide. Postoperative examinations revealed that the patientchr('39')s endotracheal tube cuff had a hernia which blocked the airway; the problem was resolved and surgery continued. Diagnosis and treatment of this case have important and significant points that are mentioned below.

Structural defects in the endotracheal tube and its cuff may cause insufficient ventilation of the patient and reduce the delivery of anesthetic gases to the patient. The definitive solution to endotracheal tube cuff defect is replacement, but conservative measures may be used as a temporary solution in some clinical situations. The anesthesia team should be prepared with adequate equipment, programs, and personnel to follow “​Guidelines for Management of the Difficult Airway” developed by the American Society of Anesthesiologists (ASA) in the case of loss of air exchange in the patient.

Chronic urticaria is a common skin condition that is manifested with erythematous or white edema, itching, and transient dermis with or without angioedema. Due to insufficient knowledge of the etiology of many of these chronic lesions, this study was performed to investigate some factors related to individual and laboratory indices of patients.

In this descriptive study, 210 patients (154 females and 54 males) with chronic urticaria referred to Asthma and Allergy Clinic of Ahvaz from September 2015 to February 2019 were evaluated. Routine tests were performed for all patients including blood cell count, antinuclear antibodies, thyroxine and thyroid stimulating hormones, anti-thyroperoxidase (TPO) and anti-thyroglobulin (Tg) antibodies, glutamate-oxaloacetate transaminase (GOT) and glutamate-pyruvate transaminase (GPT) enzymes, autologous serum skin test and stool test.

Of all patients, 166 (79%) had physical urticaria, 125 (59.5%) had atopy and 158 (75%) had angioedema. Autologous serum skin test with a frequency of more than 74.28% was positive in patients. Except for 3 patients (1.42%) with low serum levels of thyroid stimulating hormone and normal thyroxine (mild hypothyroidism) and 49 patients (23.33%) with abnormal increase in anti-thyroperoxidase and anti-thyroglobulin serum antibodies, the rest of the subjects (75.23%) were healthy. The results of anti-nuclear antibody and stool tests were also generally normal.

Based on the results of this study, in order to diagnose patients with chronic urticaria with or without angioedema, it is necessary to perform autologous serum skin test and thyroid function tests along with detailed clinical examinations.

COVID-19 started in December 2019 in Wuhan, China and quickly became a global pandemic. According to studies, traditional medicine interventions along with conventional medicine protocols have been reported to be effective in prevention and treatment. The aim of this study was to summarize the recommendations of Persian medicine based on evidence in the prevention and treatment of symptoms of acute respiratory syndrome.

In this review article, keywords related to the symptoms of COVID-19 in Persian medicine sources, review and items related to the prevention and treatment of acute respiratory syndrome were extracted. Individual items with the keywords "Influenza" or "SARS" or "MERS" or "COVID-19" or "Coronavirus" or "Antiviral" or "Anti-inflammatory" or "Immune system" or "Antioxidant" were searched in the databases SID, Pubmed, Scopus, Cochrane, Web of science, Science direct, and Google scholar, and finally those with scientific evidence were presented in the form of auxiliary instructions for prevention and treatment.

A significant part of the recommendations of Persian medicine to prevent or control the symptoms of acute respiratory syndrome has practical clinical evidence. These include social distance, avoiding heavy meals, and using herbal remedies according to the specific conditions of the patients.

According to the results of this study, the use of simple strategies of Persian medicine in preventing and improving the symptoms of acute respiratory syndrome caused by COVID-19 along with common medicine protocols, can help control the epidemic conditions. Also, many of these recommendations can be evaluated as useful research ideas in the prevention and treatment of COVID-19.

Streptococcus pneumoniae is one of the main etiologies of meningitis, pneumonia, sinusitis, and middle ear infection associated with significant morbidity and mortality. This report aims to review and report the serotype distribution and antimicrobial resistance patterns and determine the frequency of S. pneumoniae in Iran.

A systematic literature review of the literature published from January 1990 to August 2020 was performed to identify articles that have been published in Google Scholar, Scopus, PubMed, SID, IranMedex, and Magiran databases that describe the serotype distribution, antimicrobial resistance patterns and frequency of S. pneumoniae in Iran. The search terms were "Streptococcus pneumoniae, Antibiotic resistance, Serotyping, Systematic review, and Iran". The exclusion criteria were review articles or case reports, reports only emphasizing on serogroups rather than serotypes, and having isolates fewer than 10.

Of 56 reports, 33 publications that met our inclusion criteria were selected for data extraction and analysis. The frequency of S. pneumoniae in patients and carriers was estimated at 1.5% and 20%, respectively. Highest levels of resistance were against co-trimoxazole followed by penicillin, and erythromycin. The most common serotypes were 23F followed by 19F, 6A/B, 19A, and 18C.

Based on the results of this study, the inappropriate use of antibiotics and the subsequent spread of resistant pneumococcal isolates in our country is worrisome.

Producing a new sealer using local technology helps to produce dental materials with ideal properties in the country and at a lower cost. The present study was performed to investigate the physical properties of a calcium silicate- and hydroxyapatite-based endodontic sealer in three different mass compositions.

In this laboratory study, a new sealer was made in Mashhad Dentistry School. Three different weight ratios in the experimental groups S1= Cs Si Sr, S2= Cs Si2 Sr and S3= Cs Si Sr2 were evaluated in terms of setting time, working time, film thickness, solubility, and flow. Experiments were performed according to ISO/FDIS6876:2012 standard. To determine the crystal structure of the sealer in three different formulas, the samples were examined by X-ray and Energy-dispersive X-ray Spectroscopy.

The highest amount of flow was related to S1 (17.08 mm) and the lowest amount was related to S2 (16.2 mm). The lowest solubility was related to the formula S1 (1.83%) and the highest was related to S2 (3.6%). Experiments also showed that the amount of film thickness in the formula S2 and S1 have the highest and lowest levels, respectively. Setting time in the samples was 330 minutes in S1, 428.33 minutes in S3 and 1030 minutes in S2. S1 had the longest working time, followed by S3 and S2, respectively.

Based on the results of this study, sealers S1 and S3 showed good results in accordance with the standards in setting time, working time, film thickness, solubility, and flow tests, but sealer S2 showed results close to the standard.

In vitro proliferation and maintenance of spermatogonial stem cells is one of the treatment options for infertile men. Creating a suitable microenvironment similar to the natural conditions of reproduction of these cells leads to the improvement of culture and spermatogenesis. Therefore, the aim of the present study was to use a 3D silk nanofibrous electrospun scaffold and co-culture with Sertoli cells in order to increase the proliferation of spermatogonial stem cells.

In this experimental study, spermatogonial stem cells were isolated from the testes of 50 2-4-day-old mice (5 samples each time) using two-step mechanical and enzymatic digestion within two weeks. After placing 2×104 cells on the surface of the silk scaffold, they were exposed to culture medium. The viability of these cells was assessed using MTT assay and their binding was evaluated by SEM microscopy. The studied variables, including Stra8, DAZL and Piwill2 specific genes were analyzed by real time PCR and immunocytochemistry.

The viability of cultured cells in the presence of scaffold and Sertoli (91±6), (90±2) was higher than the control group (85±2), (83±8). Real time PCR results confirmed a significant increase in the expression of specific markers of spermatogonial stem cells such as Stra8, Piwill2 and DAZL in cells cultured respectively on scaffold (1.47±6) (1.28±5) (1.43±2) compared to the 2D culture group (1.17±5) (1.05±3) (1.13±7) (p<0.05).

The results showed that silk scaffold in the presence of Sertoli cell co-culture can increase in vitro proliferation of spermatogonial stem cells and can have a positive effect on the viability and proliferation of these cells.

Mandibular second premolars are the third most frequent impacted. By evaluating the three-dimensional position of the impacted tooth and timely treatment, possible problems and damage to adjacent structures can be prevented. This study was designed to assess the position of Impacted Mandibular Second Premolar (MnP2) as well as the effect on adjacent structures using CBCT imaging due to the lack of adequate studies in this field.

This cross-sectional study was performed on 25 impacted mandibular second premolars. Two radiologists assessed and compared CBCT images to determine the following variables: unilateral/bilateral, position of the crown, root resorption of the adjacent permanent teeth, root dilaceration, depth of impaction, type of impaction, pathology incidence, residual primary tooth, position and distance to inferior alveolar nerve canal and the mental foramen.

In most cases, unilateral impaction was seen (19(76%), p=0.063). Crown position of most of MnP2 was displaced lingually (17(68%), p=0.324). Vertical and distoangular position of tooth were more common (12(48%) and 5(20%), p=0.922). Root resorption of the adjacent permanent teeth and dental pathologies did not occur in any of cases. Most of Mnp2 were categorized under the classification as mild (14(56%), p=0.270).

According to the results of the present study, it is unlikely that the MnP2 of young patients analyzed in this study would adversely affect adjacent structures.

Patients with penetrating abdominal trauma can be treated with invasive procedures such as laparotomy and less invasive procedures such as laparoscopy. Since the management of patients with penetrating abdominal trauma based on non-invasive methods is more important, the present study was performed to compare laparoscopic and laparotomy methods to evaluate the surgical outcomes, complications and costs of patients with penetrating abdominal trauma.

In this retrospective study, the records of all patients with penetrating abdominal trauma and stable hemodynamics referred to Kowsar Hospital in Sanandaj during one year were reviewed. Patientschr('39') information including demographic characteristics, rate of laparotomy or laparoscopy surgery, time of operation, surgical wound infection, incidence of ileus, patientschr('39') pain intensity, length of hospital stay and hospital costs were collected and reviewed based on patientschr('39') records.

In this study, the medical records of 40 patients were reviewed. The average pain intensity in the laparoscopy group was 2.03±0.69 and in the laparotomy group was 6.77±1.95. Postoperative ileus was seen in 3 patients (16.66%) who underwent laparoscopy and 17 patients (77.2%) who underwent laparotomy. The average number of hospitalization days in the laparoscopy group was 1.38±0.61 days and in the laparotomy group was 5.73±1.78 days. The average cost of surgery in laparoscopic surgery was equal to 532240 Rials and in laparotomy was 1365600 Rials (p=0.0001).

According to the results of this study, it seems that the use of diagnostic laparoscopic method for the management and treatment of patients with penetrating abdominal trauma and stable hemodynamics, significantly reduces complications and minimizes costs and length of hospital stay.

Acute lung injury is characterized by accumulation of neutrophils in the lung, interstitial edema, and damage to the alveolar epithelium. Lipopolysaccharide (LPS) causes an inflammatory response and the release of reactive oxygen species and cellular and tissue damage to the lungs. Considering the role of oxidative stress in infections and proving the antioxidant properties of montelukast in several studies, the effect of montelukast on acute lung injury induced by lipopolysaccharide (as a model of infection) in dogs was investigated in this study.

In this experimental study, 20 healthy dogs (both male and female dogs of native breed with an average weight of 20 kg) were divided into four equal groups. The first group received oral montelukast (1 mg/kg), the second group received intravenous LPS (0.1 µg/kg), the third group received montelukast one hour before LPS and the fourth group received montelukast one hour after LPS. Bronchoalveolar lavage and blood sampling were performed at hour zero and 1.5 hours after the start of the test and the amount of malondialdehyde, catalase activity, glutathione peroxidase and total antioxidant capacity in serum and lavage fluid were measured using a kit.

LPS significantly increased malondialdehyde levels (from 10.5 to 139.8 μmol) and decreased catalase activity (from 0.018 to 0.007 μmol) (p= 0.0001), glutathione peroxidase (from 259 to 76.5 nmol) and the total antioxidant capacity (from 0.41 to 0.04 nmol) compared to hour zero. These changes were significantly adjusted by montelukast (p≤ 0.02).

The results of this study showed that montelukast can enhance antioxidant defense against acute lung injury induced by LPS.

Risk assessment is one of the most important strategies in estimating the risk of cardiovascular disease and controlling the risk factors. In Iran, half of all deaths and 79% of deaths due to non-communicable diseases are attributed to cardiovascular diseases. The aim of this study was to analyze the results of cardiovascular disease risk assessment program in Mazandaran province.

This cross-sectional study was performed in 2019 on 600 patients referred to comprehensive health centers of Noor and Mahmoudabad cities in Mazandaran province. The data collection tool was a checklist containing the risk factors studied in the SIB system. Descriptive statistics such as mean, standard deviation, frequency and percentage as well as analytical statistical tests such as chi-square, regression and analysis of variance were used using SPSS software version 19.

The prevalence of risk factors for cardiovascular disease including history of diabetes, history of hypertension, obesity, high cholesterol, family history of diabetes and heart disease were 36.5%, 45.5%, 42.3%, 34.8%, 23.5% and 10%, respectively. The four variables of age, history of diabetes and hypertension, and blood cholesterol levels were significantly associated with the 10-year risk of cardiovascular disease. With increasing one year of age, the 10-year risk level increased by 15% (p<0.001), and by seven times in people with a history of diabetes (p<0.001) and increased by 83% in people with a history of high blood pressure compared to others individuals (p=0.022).

The results of the study showed that in Mazandaran province, four variables of age, history of diabetes and hypertension and cholesterol levels are the most common factors that are associated with 10-year risk of cardiovascular disease.

There are several techniques for preserving the rectum in Low Anterior Resection (LAR) and preventing permanent ostomy. However, the superiority of these techniques is still under debate. The aim of this study was to compare the performance and clinical outcome of three methods of straight, side-to-end, and colonic J-pouch colorectal anastomosis in patients with rectal cancer referred to Imam Khomeini Hospital in Sari.

In this prospective single-blind clinical trial, all 75 patients with rectal cancer over the age of 18 years with primary rectal tumor with resection capability and position of the lower or middle rectum 4 to 12 cm from the anal canal, during the period of 2017 to 2018 referred to Imam Khomeini Hospital in Sari, were randomly divided into three groups of 25 people using block sampling: (the first group: low anterior resection with straight anastomosis, the second group: surgery with colonic J-pouch and the third group: side-to-end anastomosis). Functional outcomes (measured by Wexner criteria) and surgical complications were compared in the two groups, and patients were followed up to evaluate the functional features of the anastomosis.

60 patients including 29 women (48.33%) and 31 men were analyzed. The mean age of patients was 58.32±14.91 years. The mean length of surgery, median hospitalization and median bleeding in patients undergoing J-pouch anastomosis were 178.65±14.21 minutes, four days and 500 ml, respectively. No surgery-related complications were seen in the three groups. The Wexner criterion showed the superiority of patients who underwent J-pouch anastomosis surgery in the variables of daily defecation frequency, fecal incontinence and emergency defecation compared to the other two groups (p<0.001, p<0.005, p<0.022).

The results of this study showed that the performance indices of patients with rectal cancer in people undergoing J-pouch anastomosis are better compared to side-to-end and straight methods.

Vitamin A in the immune system is considered as an anti-inflammatory vitamin that has anti-infective effects in infectious diseases. Therefore, this study was performed to evaluate the effectiveness of vitamin A as one of the complementary therapies in the treatment of brucellosis.

In this experimental study, 110 people were selected as brucellosis patients based on serological test and were placed in two groups of control and intervention. In addition to the usual drugs for the treatment of brucellosis, patients in the intervention group received oral vitamin A at a dose of 25,000 units pre day for 6 weeks, and patients in the control group did not receive vitamin A. After the intervention, the response to treatment was evaluated based on the number of days of fever, chills, sweating, arthralgia, myalgia, anorexia, chronicity and recurrence using standard methods in the two groups.

In terms of days with fever (14.72±27.61 vs. 53.45±141.14), sweating (19.27±28.98 vs. 61.09±142.35), arthralgia (56±96.83 vs. 53.45±158.18), myalgia (13.45±27.23 vs. 52.36±141.44) and anorexia (13.30±47.39 vs. 51.81±129.8), a significant decrease was observed in the intervention group compared to the control (p<0.05). There was no difference between the intervention and control groups in terms of chills (p=0.122). The recurrence rate in the control and intervention groups was 25.5% and 7.3%, respectively, and the chronicity rate was 3.6% and 0%, respectively, which was statistically significant (p<0.05).

Based on the results of the study, it can be said that vitamin A leads to faster improvement of brucellosis symptoms and it can be used as a complementary treatment for brucellosis.

COVID-19 virus has affected the health and economy of countries with a widespread epidemic worldwide. Overcoming this situation requires identifying the factors effective on controlling and coping with this epidemic to increase resistance to the virus and contribute to the social, economic and social development of the community. The purpose of this study is to present a model and ranking of factors affecting the counteraction to COVID-19 pandemic in Babol, northern Iran.

This cross-sectional study was performed on 280 officials and executive staff involved in COVID-19 control in Babol through simple random sampling method. In order to provide a model and ranking of factors effective on controlling and coping with COVID-19, researcher-made questionnaires including 63 questions and ten factors of public notices and relations, educational factors, organizational factors, cultural factors, social factors, health processes, crisis management, motivation, extracurricular collaborations, and epidemiological and demographic factors were designed based on scores of 1 to 5 in Likert scale, and then the model was tested and the factors were ranked.

The results show that the model of factors effective on controlling and coping with COVID-19 has a good and strong fit and the ranking of these factors in Babol includes public notices and relations (6.19), educational factors (06.07), organizational factors (06.06), cultural factors (5.89), social factors (5.60), health processes (5.48), crisis management (5.46), motivation (4.85), extracurricular collaborations (4.79) and epidemiological and demographic factors (4.62), respectively.

The results of the study showed that these ten factors were effective in counteracting and controlling COVID-19 in Babol, among which, public notices and relations and education had a more effective role.

Gentamicin is one of the aminoglycoside antibiotics that commonly causes nephrotoxicity. Antioxidants are effective in reducing gentamicin-induced nephrotoxicity. In this study, we investigated the possible effect of L-Glutamine on the reduction of renal tissue damages and renal function recovery in gentamicin-induced nephrotoxicity in rats.

In this experimental study, 32 rats were divided into four groups of eight: Sham group, Gentamicin group (100 mg/kg i.p for 12 days), L-Glutamine group (30 mg/kg by gavage for 12 days), Gentamicin+L-Glutamine group. Then through anesthesia, the blood sample was collected via cardiac and its serum was used to measure the BUN and creatinine levels. The kidney of the rat was used to measure malondialdehyde (MDA), glutathione peroxidase (GPX), catalase (CAT), glutathione (GSH) and determine histopathological parameters.

Receiving gentamicin causes significant elevation in BUN, Creatinine, MDA of the kidney, tubular necrosis, eosinophilic cast, and leukocyte infiltration compared to sham group (p<0.05). CAT, GPX, and GSH in gentamicin group caused significant decrease compared to the sham group (p<0.05). Glutamine has significantly decreased the MDA level, and leukocyte infiltration compared to gentamicin group (p<0.05). Glutamine caused significant increase in GPX (CAT in group 4) compared to gentamicin group (p<0.05) and in group 3, BUN, tubular necrosis, eosinophilic caused significant decreases compared to gentamicin group (p<0.05).

Receiving L-Glutamine, 30 mg/kg orally for 12 days has an effective role in the reduction of kidney injuries induced by gentamicin.

Donohue syndrome (DS) is an extremely rare and usually fatal inherited disease resulted from mutations in the INSR (Insulin Receptor) gene and delineated by severe insulin resistance with fasting hypoglycemia, postprandial hyperglycemia, and facial dysmorphism. Optimal treatment of these cases is unclear and most DS cases die during the first two years of life. Herein, we introduce a case of leprechaunism due to the rarity of this syndrome (one case in every four million birth) revealed by clinical and laboratory findings.

 We present a 4-day old boy with an abnormal facial appearance, low birth weight who was admitted to the Neonatal Intensive Care Unit (NICU) due to poor feeding and jaundice. The patient had coarse facies, hypertrichosis, abdominal distention, genitomegaly, and acanthosis nigricans. Laboratory examinations revealed fasting hypoglycemia, postprandial hyperglycemia, and hyperinsulinemia. The diagnosis of Donohue Syndrome was characterized by the combination of dysmorphic features and biochemical results. Supportive care such as normalizing blood glucose and continuous feeding was initiated. He was discharged with good condition several days later but was admitted again at 6 months of age due to sepsis and then died.

According to the present case report, close monitoring of blood glucose as well as caring to prevent infection and sepsis is recommended.

Cancer is one of the challenges of the medical world. Recently, in the search for new compounds with anti-cancer properties, attention to natural compounds has increased. The aim of this experimental study was to investigate the anti-cancer properties of various concentrations of aqueous and hydroalcoholic extracts of Zophobas morio (Coleoptera: Tenebrionidae) larvae, as a mass-rearing and available insect, on breast cancer cells.

In this experimental study, the insect was reared at a temperature of 25 °C and a relative humidity of 60% on wheat bran. At the final larval stage, the insects were dried and pulverized. Breast cancer cells (MCF-7) and normal cells (HUVEC) purchased from Pasteur Institute, were treated for 24 and 72 hours by different concentrations of aqueous and hydroalcoholic extracts (zero, 25, 100, 400 and 1200 μg/ml). Water was used as a control. Cell viability was measured by MTT assay. In five treatment groups, 10,000 cells of each extract were cultured in three replicates.

Adding high concentration of hydroalcoholic extract (39.42±4.48 in 24 hours, 23.52±1.82 in 72 hours) compared to aqueous extract (56.02±9.43 in 24 hours, 36.52±4.07 at 72 hours) had a better effect on inhibiting the proliferation of cancer cells (p<0.05). The effect of these extracts on normal cells was observed only in high concentrations and its amount was lower than cancer cells (aqueous and hydroalcoholic extracts [61.77±3.44 and 57.21±1.10 in 24 hours] and [39.25±6.53 and 27.14±1.38 in 72 hours], respectively) (p<0.05).

The results showed that the high concentration of hydroalcoholic extract of Z. morio larvae played an effective role in inhibiting breast cancer cells, without having a significant effect on normal cells.

There is a risk of damage to the inferior alveolar nerve when extracting third molars. A variety of common imaging modalities, such as panoramic radiography (PR) and cone-beam computed tomography (CBCT), are recommended for examination prior to mandibular third molar surgery. The aim of this study was to compare the findings of panoramic radiography and CBCT in evaluating the relation between the root of the mandibular third molar and the inferior alveolar canal.

In this cross-sectional study, 75 panoramic and CBCT images were evaluated. Cases in panoramic radiography that were suspected of the relation between the root of the mandibular third molars and the inferior alveolar canal were collected. To determine the type of connection of apex and root canal, the samples were divided into 6 groups: normal, inferior alveolar canal path loss, canal path narrowing, sudden canal path change, radiolucent band over the roots, and root curvature. Cases in the panoramic radiograph that were suspected of root contact with the canal were examined by the CBCT in terms of the position of the canal relative to the tooth (buccal or lingual or middle of the root - upper or lower) and the type of connection (whether the tooth is connected to the canal).

In panoramic findings, 23 cases (30.7%) were normal, 19 cases (25.3%) showed canal path loss, 9 cases (12%) canal path narrowing, 5 cases (6.7%) sudden canal path change, 3 cases (4%) radiolucent band over the roots and 16 cases (21.3%) showed root curvature. According to CBCT findings, the position of the canal relative to the root apex was lingual in 39 cases (52%) and there was connection between the mandibular canal and the third molar in 39 cases (78.7%). There was no significant relationship between panoramic radiographic and CBCT findings and only in two cases of specific radiolucent band over the roots, there was a complete agreement between panoramic and CBCT findings.

Based on the results of this study, if a radiolucent band is observed on the root of the mandibular molars or a sudden change is observed in the canal path, panoramic radiography can be used to detect the relation between the inferior alveolar canal and the root of the third molars.

Conventional anti-inflammatory drugs, despite their beneficial effects, have serious and irreversible side effects. Due to the remarkable anti-inflammatory properties of bee pollen crude extract, the present study was conducted to investigate the effects of 100% methanol fraction (MF) and dichloromethane fraction (DF) in an air pouch model of inflammation.

This experimental study was performed on 42 male Wistar rats in 7 groups of six. First, the hairs on the back of the rats were shaved. Subcutaneous injection of sterile air (20 and 10 mL) was performed on the dorsum of anaesthetized rats (day 1 and day 3, respectively). On day 6, inflammation was induced by intra-pouch injection of carrageenan. Group I: Normal saline; Group II, III, and IV: the rats treated with 100, 500 and 2500 μg MF; Group V, VI, and VII: the animals treated with 100, 500 and 2500 μg DF by intra-pouch injection simultaneously with carrageenan after 24 and 48 h. Three days after carrageenan administration, the inflammatory parameters and angiogenesis were measured.

Compared to the control group (5.3±0.5 g), granulation tissue weight was significantly decreased (p<0.001) by approximately 30% and 40% by all three doses of MF and DF, respectively. Inflammatory parameters such as exudate volume and angiogenesis were significantly reduced by DF (p<0.001) and MF (p<0.01), respectively. In both fractions, a dose of 2500 μg increased the number of leukocytes.

Although different effects were observed in the two fractions of extract due to different amounts of flavonoids, a promising inhibitory effect on granulation tissue and angiogenesis was obtained, which could be considered as a natural source of anti-rheumatoid and anti-cancer agents.

Kawasaki disease is an acute vasculitis of childhood and can be associated with complications such as hyponatremia. The present study was conducted to evaluate the serum sodium levels and its association with cardiac complications in children with Kawasaki disease.

In this cross-sectional study, all Kawasaki patients (according to AHA criteria) referred to Amirkola Children's Hospital in Babol in 2017-2018 were evaluated. Patients underwent serum sodium assessment and echocardiography and the relationship between serum sodium levels and cardiac complications including ectasia and coronary aneurysm, myocarditis, pericarditis and coronary artery occlusion was investigated.

Of the 60 patients with Kawasaki disease, 27 (45%) were male and 33 (55%) were female. Their mean age was 32±8 months. 28 patients (47%) had serum sodium levels lower than 135 mEq/L while normal serum sodium level (135-150 mEq/L1) was reported in 53% of patients. Cardiac complications including coronary ectasia and myocarditis were reported in 16 and 32 patients, respectively. There was no significant difference between serum sodium levels and cardiac complications. There was no difference in the incidence of cardiac complications and hyponatremia in males and females.

According to the results of the present study, serum sodium levels cannot be a good criterion for cardiac prognosis.

Fever in children is one of the most common reasons that cause parents to go to the pediatric clinic for medical care. Differentiating between benign self-limiting viral disease and a serious bacterial infection is a major challenge for pediatricians. The present study was conducted to determine the etiology, clinical profile, and related factors of serious bacterial infection in children hospitalized with fever without a source.

This descriptive-analytical and cross-sectional study was performed on 241 children with fever greater than or equal to 38 ºC without other symptoms hospitalized in pediatric emergency ward of Ali-Ebne-abitaleb hospital in 2020. Demographic information and laboratory findings of patients as well as other information was obtained through history taking and recorded in information form. Then, children were examined for viral or bacterial fever in two groups.

Out of 241 examined children, 90 patients (37.3%) had severe bacterial infection (SBI) and 151 patients (62.7%) had viral infection. There was a significant difference between variables such as age, number of siblings, history of respiratory infections in parents and birth weight between the two bacterial and viral groups (p=0.001). The white blood cell count, neutrophil percentage, platelets and duration of fever were significantly different between the two groups (p=0.001).

Results showed that some laboratory and clinical factors are different between the two bacterial and viral groups and can help us differentiate them.

The omohyoid muscle is one of the muscles among the infrahyoid muscles. Due to the connections and proximity of this muscle to the brachial plexus, carotid sheath, phrenic nerve and sternocleidomastoid muscle, it is very important to be aware of all possible variations of this muscle in terms of anatomic, clinical and surgical factors.

 During the dissection of posterior carotid triangle on the left side of the neck of a 55-year-old male cadaver (who had been purchased about two years ago from Tehran University of Medical Sciences) for master's students of anatomy in the dissection room of Babol University of Medical Sciences, it was observed that instead of passing under the sternocleidomastoid muscle, the intermediate tendon of the omohyoid muscle passes through its two origins connected to the sternum and the clavicle.

This type of variation of the omohyoid muscle can be very important due to the proximity of this muscle to the surrounding elements and its effect on the large vessels of the carotid sheath and surrounding tissues.

Retinopathy of Prematurity (ROP) is a vasoproliferative retinal disease in preterm infants that can lead to disorders and blindness throughout life if not diagnosed and treated at an early age. Therefore, this study was performed to investigate the relationship between retinopathy of prematurity and various maternal and neonatal diseases.

This case-control study was performed on 828 premature infants (303 infants with ROP and 525 infants without ROP as controls) born in Ayatollah Rouhani Hospital, Babol, Iran, in 2009-2019. All medical information about maternal and neonatal diseases was collected from patient files. Preliminary eye examinations and follow-up were performed based on the local ROP treatment and follow-up guide to diagnose the stage and zone of ROP. Then, neonates were compared based on retinopathy and lack of infection in both groups in terms of maternal and neonatal diseases including congenital heart defect, premature rupture of membranes, anemia, urinary tract infection, hypertension, sepsis, transient tachypnea of the newborn, respiratory distress syndrome, gestational diabetes and preeclampsia.

Out of 828 evaluated neonates, 303 had ROP, including infants with preeclampsia (odds ratio of 2.54, p<0.001), infants with respiratory distress syndrome (odds ratio of 2.2, p<0.001) and infants with congenital heart defects (odds ratio of 1.53, p=0.047) had a higher chance of developing ROP. Moreover, infants with transient tachypnea of the newborn (odds ratio of 0.7, p<0.001) and infants with anemia (odds ratio of 0.373, p<0.001) had a lower chance of developing ROP.

The results of the study showed that maternal preeclampsia, respiratory distress syndrome and congenital heart defects are among the diseases affecting the incidence of ROP.

Fungal agents, especially Candida species, can cause fungal and life-threatening lung infections in children. The present study was performed to identify Candida isolates obtained from bronchoalveolar lavage (BAL) specimens of children admitted to Akbar Children's Hospital in Mashhad.

In this cross-sectional study, 210 BAL specimens of hospitalized children with pulmonary disorders during 27 months (April 2018 to June 2020) were examined. Routine mycology tests including direct examination with 20% potassium hydroxide (KOH) and culture on Sabouraud dextrose agar containing chloramphenicol were performed for these specimens. The genomic DNA of Candida colonies were amplified by Multiplex PCR, and Candida species were identified based on the electrophoresis pattern.

The patients included 90 females (42.9%) and 120 females (57.1%) and their age range was between 2 months to 16 years and their mean age was 4.6±3.16 years. Among clinical specimens, 20 specimens (9.5%) had direct microscopic results and positive culture for Candida. Identified Candida isolates included C. albicans in 15 cases (75%), C. dubliniensis in 2 cases (10%), C. parapsilosis in 2 cases (10%) and C. tropicalis in 1 case (5%). Among the underlying factors, corticosteroid receptors and patients with neutropenia had the highest frequency (73 patients, 34.8%).

The results of the study showed that C. albicans was the most common Candida isolate in the BAL specimen of hospitalized children with pulmonary disorders. Children under 4 years of age were the most affected group and pneumonia was the most common clinical form in patients with Candida infection.

The main and effective treatment for diabetes is the use of insulin and synthetic drugs and herbal medicines, which may be accompanied by several side effects. Given that GLP-1 secretion is reduced in diabetic patients compared to healthy individuals, the aim of this study was to determine the simultaneous effect of resveratrol and probiotics on insulin secretion and glucagon-like peptide (GLP-1) and to evaluate insulin resistance in diabetic rats.

In this experimental study, 40 adult male Wistar rats weighing approximately 250-300 g were used. Animals were randomly divided into 5 groups: control group, diabetic group (using 65 mg/kg streptozotocin and 110 mg/kg nicotinamide intraperitoneally), diabetic group treated with probiotics (50×109 bacteria/kg body wt−1 daily by dissolving in water), diabetic group treated with resveratrol (10 mg/kg by gavage method) and diabetic group treated with probiotics and resveratrol (co-administration group). After four weeks, the animals were sacrificed and pancreatic tissue and blood samples were isolated for histopathological tests and biochemical tests. Blood glucose, insulin resistance, pancreatic GLP-1 as well as pancreatic histopathology were assessed.

The co-administration group compared with the diabetic group caused a 42% reduction in serum glucose levels (p<0.001) and a 30% reduction in insulin resistance (p<0.001). The co-administration group also caused a 23.5% increase in insulin levels (p<0.001) and an 88% increase in GLP-1 (p<0.05). The co-administration group improved the histology of the pancreas.

The results of the study showed that resveratrol and probiotics are effective in controlling diabetes by increasing the levels of GLP-1 and insulin and decreasing insulin resistance.

Early diagnosis of oral diseases affects the prognosis and treatment. Despite advances in oral health, there are still oral health problems worldwide. Considering that culture, gender, age, ethnicity and habits may have a significant impact on the prevalence of lesions, this study was performed to investigate the frequency of oral lesions over 10 years and its relationship with some variables.

In this cross-sectional study, the medical records of 1092 patients with various types of oral lesions who referred to the Department of Oral and Maxillofacial Diseases of Babol Dental School during 2009-2017 were evaluated and compared based on year, age, gender, type of lesion (white and red, pigmented, vesiculobullous, orofacial and tumoral pains, and disorders associated with systemic and peripheral or central diseases).

In this study, out of 1092 cases, 672 cases were related to female clients (61.5%) and 420 cases (38.5%) were related to male clients (p<0.001). The mean age of the subjects was 43.2±16.81 years. The highest frequency was related to white and red lesions with 305 cases (27.9%), which was 193 cases in women (28.7%) and 112 cases in men (26.7%) (p<0.001). The highest frequency of lesions was related to the cheeks with 351 cases (32.1%) including 235 cases (35%) in women and 116 cases (27.6%) in men (p<0.01). The lowest frequency was observed in the floor of mouth in 68 cases (6.2%). Tumoral lesions had a higher mean age of involvement than other lesions (p<0.001). The frequency of orofacial pain and burning symptoms in women was significantly higher than men (p=0.006).

The results of the study showed that the frequency of white and red lesions of the mouth is more than other cases and its most common location is in the buccal mucosa. The frequency of lesions also has a significant positive relationship with female gender.

Dentists are at risk for respiratory diseases such as COVID-19 due to the nature of their occupation, close contact with patients, and exposure to microdroplets. One of the most important psychological variables affecting the regular implementation of preventive health behaviors is fear. Therefore, the present study was conducted to determine the relationship between knowledge, fear and attitude, and COVID-19 preventive behaviors in dentists.

In this cross-sectional study, based on multi-stage sampling method, 190 dentists in Tehran were included in the study. Data were collected based on self-administered method using demographic questions: the 8-item Fear of COVID-19 Scale (range of 8 to 16), the 8-item Attitude Scale (range of 8 to 40), the 15-item Knowledge Scale (range of 0 to 15), and the 12-item COVID-19 Preventive Performance Questionnaire (range of 12 to 60).

Only 24.74% of dentists received official training on COVID-19. The mean performance score of dentists towards COVID-19 prevention was 52.2±7.6 and was satisfactory. However, behaviors such as preparing disinfectants and masks for patients, regular air conditioning and disinfection of surfaces were observed in 38.95%, 17.37% and 16.32% of dentists, respectively. Preventive performance was significantly correlated with fear (p<0.05, r=0.427), attitude (p<0.01, r=0.305), knowledge (p<0.01, r=0.276) and work experience (p<0.05, r=0.108). Moreover, these variables predicted 63% of the variance of preventive performance.

Based on the results of this study, the overall performance of dentists in complying with COVID-19 prevention protocols was satisfactory. Moreover, there was a significant relationship between knowledge, fear and attitude and preventive performance.

Tacrolimus belongs to the family of calcineurin inhibitors and is extensively used as an immunosuppressive drug after allogeneic organ transplant. According to the inhibitory effects of calcineurin on synaptic plasticity and memory functions, it seems that the administration of tacrolimus leads to changes in the electrophysiological responses and memory functions. Therefore, this article includes studies in which tacrolimus involvement in cognitive functions such as synaptic plasticity, learning and memory are investigated, and the possible mechanism of the effect of tacrolimus on synaptic plasticity and memory are explained.

In this narrative review article, we searched PubMed and Google Scholar databases using the keyword “Tacrolimus”, “Calcineurin”, “Synaptic Plasticity”, “Learning”, “Memory”, and “Free radicals” to provide an overview of effects of tacrolimus on cognitive functions. Finally, articles published on these topics between 1987 and 2021 were investigated.

Among the 5632 sources found, 72 articles were considered appropriate for the purpose of the research. Findings support that the administration of tacrolimus (TAC) improves cognitive functions such as learning, memory, and synaptic plasticity. Furthermore, TAC has neuroprotective effects against oxidative stress-mediated cognitive dysfunctions.

The results of the study showed that TAC may improve learning, memory, and synaptic plasticity, possibly by calcineurin inhibition, reducing the level of free radicals, and altering calcium and glutamate levels.

Premature ovarian failure, with a prevalence of 1% in women under the age of 40, leads to serious health problems for women of childbearing age. Since the causes are not fully understood and the available treatments are associated with side effects, complementary medicine, including Persian medicine, can be helpful. The aim of this study was to report a case of pregnancy following successful treatment of premature ovarian failure.

 The patient was a 38-year-old woman with a history of 16 months of amenorrhea who had atrophic ovaries on ultrasound. Due to increased gonadotropins, decreased estradiol and anti-mullerian hormone, the gynecologist diagnosed premature ovarian failure. After referring to the Persian Medicine Clinic and after getting a history and examination, her treatment started which included lifestyle modification and medication (2 Raha capsules every 12 hours, 2 tablespoons of Sekanjabin-e-Bazoori [oxymel] a day, decoction of Chamomile and Pennyroyal 200 cc per day and Abzan [a human-sized container filled with hot water] with four plants of Hollyhocks, Chamomile, Rose, and Mallow twice a week). The patient was followed for 18 months. Menstruation occurred after 3 months and the ovaries were normal size after 8 months on the second ultrasound and 10 months after starting treatment, the patient became pregnant and the result was a healthy male baby.

According to the results of the present study, Persian medicine can be effective in treating infertility caused by premature ovarian failure.

Testicular cancer is almost the only common genitourinary tract cancer at a young age. One of the risk factors for testicular tumors is undescended testicles. If testicular fixation is corrected in the normal position, the probability of testicular cancer decreases in the undescended testicle before puberty, but it does not disappear, and the patient should be examined for a long time. The purpose of this case report is to introduce a patient who, despite undergoing orchidopexy, has developed asynchronous bilateral testicular cancer, which shows the importance of long-term follow-up in people with a history of undescended testicles.

 The patient was a 54-year-old man with a history of congenital bilateral undescended testicles, infertile, and orchidopexy surgery in childhood and a history of classic seminoma in the left testicle four years ago. Again, in periodic follow-ups and examination of the right testicle, a mass in the right testicle was touched, which showed malignant changes in the ultrasound. Serum levels of testicular markers were normal. According to the sonographic findings, examinations and patient records, the patient underwent radical right testicular orchidectomy. Classic seminoma was reported in the results of right testicle pathology, and in further examinations, no evidence of metastasis was seen. The patient is currently undergoing follow-up and postoperative chemotherapy.

According to the results of this case reported in patients with intangible testicles, especially bilateral, long-term follow-up is necessary for asynchronous bilateral testicular cancer.

Diabetes is the most common endocrine disorder in the world. Understanding the cutaneous manifestations associated with diabetes can help in choosing the appropriate treatment approach in these patients. The aim of this study was to evaluate the frequency of cutaneous manifestations in diabetic patients referred to the endocrinology clinic of Babol University of Medical Sciences.

The present cross-sectional study was performed on 300 patients with diabetes referred to Rouhani Hospital in Babol in 2019. Age, gender, BMI, type and duration of diabetes, and patients’ diabetes control status (HbA1C) were recorded and patients were thoroughly examined by a dermatologist and divided into two groups of below and above 50 years. In terms of cutaneous manifestations, they were divided into two groups; with cutaneous manifestations and without cutaneous manifestations.

293 patients (97.76%) had type 2 diabetes. The mean age of patients was 55±12 years and the mean duration of diabetes was 9.73±1.20 years. In this study, 130 patients (43%) had cutaneous lesions, of which 76 patients (58.5%) were female. Pruritus, acrochordon, cherry angioma, diabetic dermatopathy, fungal skin infections with frequencies of 25.7%, 21%, 14.3%, 6% and 5.7% were the most common skin disorders, respectively. 68 patients (69.4%) had skin manifestations and had diabetes for more than 10 years. There was a significant difference between the two groups of with and without cutaneous manifestations, gender and duration of diabetes (p<0.001). There was no significant difference between the mean age, BMI and HbA1C in the two groups (p=0.07, p=0.09 and p=0.11, respectively).

The results of the study showed that pruritus and acrochordon are the most common cutaneous manifestations and long-term diabetes and female gender are the most important risk factors for cutaneous manifestations.

Breast cancer is the most common cancer in women and the leading cause of cancer death in women worldwide. The ERBB4 gene, a member of the tyrosine kinase family, has been identified as both a tumor suppressor and an oncogene in breast cancer. In this study, the association between rs1972820G>A polymorphism of ERBB4 gene and the risk of breast cancer in northwestern Iran was investigated.

This case-control study was performed on 89 women with breast cancer and 98 healthy women with no family history of cancer. Clinical characteristics of patients included age (less than, greater than or equal to 49 years and unknown), involved side (right, left, both and unknown), type of tumor (ILC, IDC, other types and unknown), tumor grade (I, II or III), tumor size (T1, T2, T3 and unknown) and lymph node involvement (N0, N1, N2, N3 and unknown). Single nucleotide polymorphisms were examined by TETRA-ARMS-PCR technique.

The genotypic distribution of sick and healthy individuals was 66% and 56% for AA genotype, 9% and 6% for GG genotype and 25% and 38% for AG genotype, respectively. The frequency of Allele A was 147 and 140 and the frequency of G Allele was 49 and 38 in patients and controls, respectively (p>0.05).

The findings of this study showed that there is no significant relationship between genotypic and allelic distribution of rs1972820 polymorphism of ERBB4 gene with increased risk of breast cancer and clinical features of patients in northwestern Iran.

Tracheostomy is one of the most common surgeries in patients with upper airway defects. Tracheostomy is a surgical procedure to open a side passage through the neck into the trachea to stabilize the airway. The complications of this operation are very important, common and at the same time preventable. The purpose of this article is to report a case of a fractured fragment of tracheostomy tube entering the left bronchus.

 The patient was a 34-year-old man diagnosed with amyotrophic lateral sclerosis and quadriplegia, who has had a tracheostomy tube for 7 years, who referred with complaint of shortness of breath following a tracheostomy tube fracture. The patient had 60% saturation and significant respiratory distress. After confirming the fracture of the tracheostomy tube with a CT scan of the lung, the fractured fragment was removed with rigid bronchoscopy and the tracheostomy tube was re-inserted for the patient. The patient was discharged from the hospital two days after tracheostomy.

In case of shortness of breath and decreased saturation, tracheostomy tube fracture should be considered. Proper cleaning and planned replacement of the tracheostomy tube may prevent this complication.

Non-alcoholic fatty liver is one of the most common causes of chronic liver disease and is considered as one of the hepatic manifestations of metabolic syndrome, and since one of the effective treatments for this disease is exercise, the aim of this study was to evaluate the changes in Fetuin-B and retinol binding protein 4 (RBP4) during eight weeks of high-intensity interval training (HIIT) in women with fatty liver.

This experimental study was performed on 25 women with fatty liver disease in the age range of 30-50 years in two groups of training (n=13) and control (n=12). The training group was included in the intermittent high-intensity exercise protocols (8 weeks and four sessions per week and each session for 48 to 60 minutes) and the control group participated in the study without any intervention. Fetuin-B and RBP4 were evaluated and compared by ELISA using a kit made by Elabscience Inc.

The results of the present study showed that the levels of Fetuin-B in the training group (752.50±191.23) had a significant decrease compared to the control group (1141.90±227.23) (p=0.001). Moreover, RBP4 had a significant decrease in the training group (25.42±1.11) compared to the control group (30.33±3.09) (p=0.001).

The results of the study showed that a course of high-intensity interval training can be a suitable and preventive strategy to improve Fetuin-B and RBP4 levels in women with fatty liver.

Organizational citizenship behavior is a performance beyond job duties that can lead to professional behavior and improve the performance of the organization and the quality of services. Considering that the physical health of nurses is one of the requirements for the quality of their performance, this study was conducted to investigate the relationship between organizational citizenship behavior and professional behavior mediated by nurses' physical health.

This cross-sectional study was performed in 2019 among 350 nurses working in Amirkola Children's Hospital, and Yahyanejad, Shahid Beheshti and Ayatollah Rouhani Hospitals affiliated to Babol University of Medical Sciences. Using a four-section questionnaire, including Demographic Characteristics Questionnaire, Podsakoff Organizational Citizenship Behavior Scale (24 items with a score range of 24-120), Goz Nursing Professional Behavior Scale (27 items with a score range of 27-135) and Physical Health Questionnaire (14 items with a score range of 14-98), the required data were collected and evaluated.

There were 245 female nurses (70%) and 105 male nurses (30%). The age of 59.4% of subjects was in the rage of 30-39 years. The mean value of organizational citizenship behavior was 75.77±17.93 and the mean value of professional behavior was 102.30±18.27. The relationship between organizational citizenship behavior and professional behavior was direct and significant (path coefficient=0.481, p<0.001). The mean value of physical health was 47.17±10.80 and physical health played a mediating role in the relationship between organizational citizenship behavior and professional behavior (p<0.05).

The results of the study showed that there was a direct relationship between organizational citizenship behavior and professional behavior and the mediating role of nurses' physical health in this regard was confirmed.

The activity of the cardiovascular system is carried out by the Autonomic Nervous System (ANS). ANS itself is controlled by multiple nerve centers. At present, there is little and scattered information about them in Persian language. The aim of this review article is to collect information about nerve centers that control ANS and their relationship with cardiovascular activity in Persian.

In this review article, by searching the international and national databases of web of science, Scopus, Google Scholar, PubMed, ISC and Magiran until 2020 and using the keywords cardiovascular system, baroreflex, the rostral ventrolateral medulla (RVLM), the caudal ventrolateral medulla (CVLM), the nucleus tractus solitarius (NTS), the hypothalamic paraventricular nucleus (PVN), the hypothalamic supraoptic nucleus (SON), amygdala, raphe nucleus, the periaqueductal gray (PAG), cuneiform nucleus (CnF), the rostral ventromedial medulla (RVM) and the pedunculopontine tegmental nucleus (PPT), data about Autonomic Nervous System were collected.

Evaluations have shown that the most important brain centers for regulating blood pressure are the rostral ventrolateral medulla, the nucleus tractus solitarius, the hypothalamic paraventricular nucleus, the periaqueductal gray, and raphe nucleus, which control cardiovascular activity mainly by affecting the sympathetic system.

According to the results of this study, the maintenance of basal blood pressure, heart rate regulation and reflex control of blood pressure and heart rate are mainly done by autonomic and especially sympathetic nerve centers.

Orofacial clefts are the most common congenital facial defect. Genetic and environmental factors play a role in their development. The prevalence of orofacial clefts in Qom province has not been studied so far. The aim of this study was to evaluate the prevalence of orofacial clefts and associated factors in infants born in Qom province during 2010-2018.

In this cross-sectional study, during nine years, the medical files of all infants with orofacial clefts and the files of their mothers in all hospitals of Qom province were examined. The files of 476 healthy infants were also evaluated to investigate the associated factors. Healthy infants were selected one number before and one after the case number of sick infants. Infant-related variables (weight, blood type, and other illnesses) and parent-related factors (age, smoking, alcohol, and medications, illness, consanguineous marriage, and number of children) were extracted through reviewing the files or telephone interview.

Of the 171,270 infants, 238 were found with orofacial clefts (1.39 per 1,000 births). Isolated cleft palate with 39.5% was the most common type of anomaly. Among the studied factors, the percentage of smoking in fathers in the case group (34.5%) was higher than the control group (24.2%) (p=0.004). Moreover, the history of maternal high blood pressure in the case group (7.6%) was higher than the control group (3.4%) (p=0.013). The incidence of diabetes in mothers of the case group (18.9%) was higher than the control group (8.2%) (p=0.001).

The results of the study showed that the prevalence of orofacial cleft is 1.39 per 1000 births and smoking, diabetes and high blood pressure are the associated risk factors.