فصلنامه علوم پزشکی دانشگاه آزاد اسلامی مشهد
سال ششم شماره 3 (پیاپی 23، پاییز 1389)

Oral insulin is the most familiar and easiest way of prescribing insulin. Thus, the aim of this study was to produce newly formulated Chitosan-coated insulin nanoliposomes as well as evaluate their potential efficacy for delivery in the condition of in vitro.Nanoliposomes encapsulating insulin with negative surface charge were produced using the method of reverse phase evaporation Lecithin, cholesterol, cetyl-diphosphate and β-cyclodexterin were used for producing nanoliposomes. Then, nanoliposomes were coated with Chitosan solution using incubation. Having been dissolved, the nanoliposomes were evaluated for encapsulation efficiency using the technique of spectrophotometry. Using incubation method, the destructive effect of Peptic and tryptic on the insulin containing nano capsules was determined and compared to their effect on free insulin. Insulin entrapment efficacy for the newly-formulated nanoliposomes was significantly (p<0.05) higher (79±0.16) than that of the other formulations. In all conditions, the insulin contained in Chitosan–coated nanoliposomes was highly protected from digestive effect of peptic and tryptic as compared to the uncoated nanoliposomes which did not protect the insulin from digestion. The results clearly suggest that the produced nanoliposomes may be considered as an appropriate alternative for the purpose of oral insulin delivery.

Amphotericin B (AmB) is an old antifungal agent and the drug of choice for systemic fungal infection. Unfortunately, this antibiotic has shown some dose dependent side effects such as nephrotoxicity. Therefore, recently this study aimed at producing a newly-formulated in the codition of in vitro in order to reduce the effect of toxicity in this drug as well as increase its effectiveness.AmB nanocapsules were made from polymers, such as poly D and L-lactide-co-glycolide by means of a solvent displacement technique. The nanocapsules suspensions were then made into dried powder through the nanoprecipitation of polyesters using SiO2 as adjuvant. Next, the efficacy of the capsulated AmB was measured using spectrophotometry technique to be assessed and compared with other formulations. Besides,the MICs of these nanocapsules for Candida albicans (ATCC 90028) was determined and compared to those of the respective free AmB, using microdilution method. Finally, the effect of in vitro toxicity (haemolysis) of the nanocapsules was determined on human RBCs.Drug entrapment efficacy for nanocapsules was calculated as 75% ± 0.13. The MICs of AmB nanocapsules against Candida albicans tested were reduced as compared to those of free antibiotic. The AmB-loaded nanocapsules was found to be 5.89 times less toxic than free AmB in terms of the effect on RBCs. The results suggest that new AmB-loaded nanocapsules produced in this research may be an appropriate alternative for AmB to be used in the treatment of fungal infections.

Some studies conducted so far suggest that exercising during adolescence and young age can increase the amount and density of bone minerals to be stored for the age of senility. However, it has not been confirmed yet what type and intensity of bone minerals may provide for a maximum rate of the anabolic stimulation. Thus, the purpose of this study is to compare the amount and density of the bone minerals in male soccer and handball professional athletes with those of male non-athletes’. This is a an experimental research study on 42 males ranging 20-30 years old who were divided into three groups consisting of: 14 professional soccer athletes (Experimental Group 1), 14 professional handball athletes (Experimental Group 2) and 14 young male non-athletes (Control Group). The athletes had the experience of at least three continuous years of regular professional exercising (3 sessions a week) and participating in national championships. These participants were selected from Mashhad athletic clubs, while the non-athletes were experiencing their first session of exercising in the club. Using DEXA, the participants’ BMD of arm femur and bone mass was measured. Then, the collected data were investigated at the significance level of 5 percent, using descriptive statistics and unilateral variance analysis as well as LSD pursuit test. The obtained results from this research indicate that there was not any significant difference among the three groups of the study in terms of BMD of the arms. Also, in terms of femur and bone mass, there was no significant difference between two groups of athletes; i.e. soccer players and handball players (P=0.465). However, the findings suggest a significant difference between the control group and soccer player group (P=0.001) and also between the control and handball player group (P=0.004). As a result, the findings of this study conform to the theory which states that bone response to the mechanical loading depends on the type and style of athletic activities.

Prostate cancer is one of the most common cancers in men and the fourth common cancer in Iran. Prostate specific antigen (PSA) is the most useful tumor indicator for diagnosing premature Prostate cancer. The specificity and sensitivity of this test increases significantly when we measure the amount of serum free PSA and calculate the percentage.This is a descriptive – analytical study that was done on 125 patients who were under prostatectomy. The patients were divided into 4 groups of <60, 60-69, 70-79 and 80 years old or above In terms of their total PSA (tPSA), the patients were divided to 3 groups of normal (0-3.9ng/ml), borderline (4-9.9 ng/ml) and increased (10-19.9 ng/ml and 20 or more). As for their percentage of free PSA (fPSA%), they were divided to 3 groups of less than 18%, 18% -25% and more than 25%. Considering the biopsy results, they made 2 groups of BPH and cancer. After that, the tPSA and fPSA% were compared for diagnosing prostate cancer using statistical particularity and sensitivity tests.The finding of the study indicate that by increasing the cut-off values of fPSA% up to 25%, the probability of being afflicted by cancer decreased, especially within the limit of tPSA of 4-9.9ng/ml by which 18.2% of cases were diagnosed as BPH, but there was no indication of cancer (P=0.0001). According to the results of our study, the tPSA within 4-9.9ng/ml was a good indicator for recognizing 7.1% cases of cancer. The rate of its sensitivity and specificity in diagnosing cancer was 20% and 77.39%, respectively. However, in combination with fPSA% cut-off 18-25%, the rate of sensitivity increased to 53.57%; and that of specificity to 86.6% (0.001). In our study, fPSA%, in combination with tPSA, was able to increase the specificity and sensitivity of the tPSA test. Especially with fPSA% cut-off 18-25% in tPSA within the borderline limit of 4-9.9 ng/ml, which was the purpose of our study, it was able to diagnose cancer to a maximum degree in addition to increasing the sensitivity and specificity. Therefore, we suggest that fPSA% be used as an aid test to tPSA, especially when the tPSA falls within low or borderline ranges which may be the an indication of cancer in early stages. So, it would increase the diagnostic accuracy of prostate cancer and decrease the costs involved.

Labor pain is the main reason preventing pregnant women from having natural vaginal delivery (NVD).In order to reduce the labor pain, several ways have been introduced, among which spinal analgesia with Fentanyl is considered the most effective.Fentanyl is a lipophilic opioid with the degree of 75-125 times more potent than morphine.This study aims at evaluating the analgesic effects of fentanyl on the process of NVD as well as the possible risks involved for the neonate after spinal injection in pregnant women.This is a single blinded clinical trial on 100 pregnant women having their first or second pregnancy who referred to Mashhad Islamic Azad University hospitals for NVD in 1389 HS. This study benefited from using the accessible method of sampling and considering he ethical issues as well applying the inclusion / exclusion criteria. Having informed the patients and their spouses about the analgesic methods, the researchers received the patients’ consent and divided them into two groups of “case” and “control” with 50 patients, each. The case group received 75 µg of Fentanyl with the concentration of 0.05 mg/ml added to sodium chloride and distilled water. These patients used the drug after getting into the cervical dilatation of 5 or 6 centimeters. The control group received no analgesic drug and experienced the natural process of labor and delivery. Systolic & Diastolic blood pressures, heart rate, SP02, the degree of cervical dilatation and effacement, fetal heart rate (FHR) and Apgar rate were evaluated during the intervals of 1 and 5 minutes after birth. Finally, these data were compared and analyzed with the statistical methods of T-test, Chi-square, Fisher and Man-Whitney, using SPSS.There was no significant difference between the two study groups in terms of maternal systolic & diastolic blood pressure, SP02 and FHR. Shortly after the injection of Fentanyl, the patients in the case group started complaining about itching in the upper part of their abdomen and chest that automatically subsided after about 20-30 minutes. There was a statistically significant difference of the pain rate between the two groups (Pearson Chi-square=62.95; df=2; p=0.0001). Mild pain was seen in 82%, moderate pain in 16% and sever pain in 2% of the patients in the case group. On the other hand, only 4% of the patients in the control group were reported to have mild pain, 22% had moderate pain and the other 74% suffered from severe pain. Duration of labor was longer for the case group and the number of cases resulting in cesarean section was not statistically different between the two groups.Spinal injection of 75µg Fentanyl provides appropriate analgesia without any considerable side effects for the pregnant women who apply for NVD

Recurrent abortion is defined as having three miscarriages before the gestational term of 20 weeks. As recurrent abortion has destructive effects on the emotional life of the couples, making attempts to sympathize with them usually leads to unverified tests and treatments. Thus, it is important to consider the possible intervening variables at work as well as having sympathetic and supportive attitudes toward the couples suffering from recurrent abortion. This way, it will not only help them come over with their emotional problems, but also helps the specialists to come up with some logical, cost effective and feasible ways of prevention and treatment. On the other hand, due to not having any remarkable improvement in diagnosing recurrent abortion and because of the importance of knowing its etiology, studies about the related factors and having plans for prophylactic and therapeutic procedures would be necessary. APL (Anti Phospholipid syndrome) is one of the major causes of abortion in the recent decades which is accordingly evaluated in this study.This cross-sectional, case-control study was done over two years (1385 and 1386 HS) in the academic research hospitals of the Medical School of Islamic Azad University in Mashhad. The subjects consist of 50 pregnant women, ranging from 20 to 40 years old, who were suffering from recurrent abortion. The control group was selected from the same range of age, having 2 full terms of pregnancy without any recurrent abortion. Some tests such as antiphospholipid antibody, lupus anticoagulant and anticardiolipin antibody were evaluated. The average age in the case group was 27; and in the control group 29 years old. 20% of the participants in the case group and 4% in the control group showed positive results from the antiphospholipid antibody test which was statistically significant (P=0.028). Anticardiolipin antibody was tested positive in 14% of the subjects in the case group and in 1% of the control group. This difference was not statistically significant (P=0.059). The two study groups were not significantly different in terms of Lupus anticoagulant (P= 0.495). Anti immune factors have been considered as one of the important factors by etiological studies on recurrent abortion that was also confirmed by this study and must be considered in the diagnosis, prophylaxis and treatment of this disorder.

Cesarean section is considered essential for protecting both the mother’s and fetus’s health. Nevertheless, in spite of being one of the safest surgical methods, cesarean section is more dangerous for mothers than vaginal delivery. According to WHO’s report, almost 15% of the deliveries can correctly lead to cesarean. However, statistics during the previous decade show a noticeable increase in the rate of cesarean. In many cases, cesarean is not a medical necessity. According to a number of studies, pregnant women prefer not to tolerate the pain that, in turn, leads to the main cause of increasing tendencies to voluntary cesarean. Having knowledge about pain reducing methods can, therefore, decrease such tendencies. This cross-sectional analytical study was conducted on 390 pregnant women referring to the public health centers of Mashhad. They filled out a questionnaire about personal and obstetric information, the kind of delivery they preferred (vaginal or cesarean), and their knowledge about pain relief methods of delivery. The findings show that the study groups; i.e. those participants who favored cesarean and those who preferred vaginal delivery, showed no significant difference in age, education, and job. The main causes of tendency to vaginal delivery were found to be the fear of anesthesia and surgery as well as willingness to see the newborn immediately after giving birth. The fear of vaginal delivery pain and the physician’s diagnosis were the main causes of voluntary cesarean. 80.80% of the participants were not aware of the pain reducing methods of baby delivery.As suggested by the findings, the main reason for having cesarean is the fear of vaginal delivery. However, the findings also suggest that the patients are not sufficiently aware of pain relief methods due to the lack of access to the adequate information being provided by the delivery centers. It seems that raising women’s knowledge about delivery pain reducing methods and their benefits can decrease their tendencies to voluntary cesarean.