مجله دانشگاه علوم پزشکی مازندران
پیاپی 125 (خرداد 1394)

Background and So far, no spatial analysis of in-hospital mortality due to myocardial infarction (MI) has been conducted in Iran. The present study was performed to determine the geographical pattern of mortality due to myocardial infarction in Iran. In a prospective hospital-based study, we used the data of cases with MI registered by Myocardial Infarction Registry of Iran, 2012. For spatial analysis, LISA, Global Moran’s I, and Getis-Ord’s statistics were used. Data was analyzed using Stata software and ArcGIS 9.3 A total of 20,750 patients was admitted to hospital due to MI and 2511 (12.1%) deaths occurred (median age at death: 65.2 ± 15.2). The incidence of death from MI did not follow a particular pattern (Moran's Index: 0.141, P-value = 0.126). The highest standardized incidence rates of in-hospital mortality from MI in 100,000 population were observed in Ardebil (31), North Khorasan (23.7), Yazd (20.2), West Azerbaijan (19.1) and Khuzestan (18.4). The lowest incidence rates were found in Sistan-Baluchestan and Khorasan provinces. This study supports the hypothesis of random pattern of mortality due to myocardial infarction in Iran.

Background and Human epidermal growth factor (hEGF) is a polypeptide of 53 amino acids with vast application in medicine such as wound healing. The purpose of this study was cloning, expression, and purification of recombinant human EGF (rhEGF) and assessment of its mitogenic effect on NIH 3T3 cells. Subcloninig of hEGF was performed in to pET24a (+). Protein expression was done under standard conditions. According to the protein expression as inclusion body, mild solubilization using alkaline pH buffer was utilized for protein solubilization. Ultimately, after refolding of solubilized proteins, MTT assay was performed to assess the mitogenic effect of rhEGF in NIH 3T3 cells treated with various concentrations of rhEGF. Mild solubilization of inclusion bodies with alkaline buffer and subsequent refolding had a very high efficiency. MTT assay showed that cells treated with our rhEGF exhibited significantly higher proliferation compared to control after 72 h (P < 0.0001). It seems cytoplasmic expression system is an efficient system for production of recombinant hEGF. The method presented in this study is a simple, accessible, affordable and of high efficiency for solubilization of inclusion bodies which is also helpful in achieving bioactive form of human epidermal growth factor.

Background and Air pollutants from cement factories and their accumulation in the environment cause various diseases and disorders in humans, plants and animals depending on the gender, size and duration of inhaled particles. Such pollutants also have synergistic effects on other air pollutants. This study was carried out for the first time to investigate the pollutants from Khouzestan Cement Company in 2013. Particulate matters, free silica and stack emissions were collected from selected stations in and nearby the Khouzestan Cement Company using standard methods. Sampling was done in calm and stable weather conditions. All statistical analyses were performed using SPSS. The results showed that maximum mean concentration of free silica and particulate matters were 5.89±3.04 mg/m3 and 137.17±16.45 µg/m3 for stone crushing and eastern stations, respectively. These rates in other stations were also found to be significantly higher than permissible exposure limits recommended by OSHA, MSHA, Iranian Department of Environment, and WHO. Currently the mean concentrations of free silica, particulate matters and toxic gases from Khouzestan Cement Company are significantly higher than national and international standards, therefore using high efficiency equipment for air pollution are recommended to control emissions from cement industry pollutants.

Background and Hard ticks are the most important vectors of some diseases including babesios, theileriosis, and Crimean–Congo hemorrhagic fever that affect both animals and humans. Among the members of this family, Rhipicephalus bursa is one of the most important vectors of babesios and theileriosis in Iran and around the world. Therefore, detection of abundance and seasonal dynamics of this species can play an important role in better understanding of the epidemiology of the diseases they transmit. A year round sampling of R. bursa was conducted from July 2007 to July 2008 in three topographical areas including: highland, woodland and lowland in Sari, Iran. The seasonal activity, species abundance and frequencies for presence or absence of the species were investigated in two hosts, sheep and cattle. Morisita index was applied to determine the similarity of species abundance in three regions. The results showed that in all study areas the highest activity of tick was observed in spring and summer which decreased to zero in autumn and winter. The highest abundance of R. bursa was found in highland in spring (n=376) and summer (n=352). The highest frequency of tick was recorded in sheep during spring in highland and lowland and during summer in woodland. Similarity index of R. bursa showed woodland and highland as the most similar areas based on species abundance. Compared to cattle, high frequency and infestation rate of R. bursa were observed in sheep flock. Therefore, control programs should be directed more in sheep and preventive measures should be taken in highland during spring and summer.

Background and Different types of dysrhythmia occur with different degrees after heart attack. Involved patients need specific care and should be admitted in coronary care unit (CCU). Visit is one of the basic needs of patients and their families during admission period but visits are limited in CCU. This research evaluated the effect of planned visits on occurrence of heart dysrhythmias in patients on CCU. In a quasi-experimental study, 60 patients with acute myocardial infarction (in Hamedan, Iran) were selected through convenience sampling in 2011. They were randomly assigned to either case group or control group. The case group was asked to name family members and significant others who they were more comfortable with and were interested in their visits. Individuals in the list were provided with appropriate training on visiting etiquette. In control group visits were done without any special training. Data was collected through a questionnaire and cardiac monitoring. Dysrhythmias were recorded in a check list before, during and after visits. Data was then analyzed in SPSS V.18. No significant difference was found in occurrence of sinus tachycardia, premature atrial contractions and premature ventricular contractions before, during and after the visits (P>0.05). But significant differences were seen in the incidence of dysrhythmias in control group before, during and after the visits (P<0.05). Planned visits positively influenced the occurrence of dysthymias and reduced the incidence of some types of dysrhythmia such as tachycardia, premature atrial contractions and premature ventricular contraction.

Background and Iran is an earthquake prone country. Women are more affected when earthquakes occur. Understanding and addressing the women’s needs for menstrual hygiene is of great importance in improving women's health. This study aimed at clarifying the perception of women about menstrualhealth needs after earthquake. The participants in this qualitative content analysis were 14 single and married women aged 18 to 45 years of old and seven health service providers. All individuals were in Zohan, Iran when earthquake occurred there in November 2012. Purposive sampling was conducted until data saturation. Data was collected by deep interviews, and writing fieldnotes. Data analysis was performed using open code. Different categories and classes were formed based on common concepts. The categories were then classified into different themes according to hidden meanings. Five themes were extracted from 288 original code including 1- exacerbation of menstrual problems in earthquake stricken areas, 2 -absence of menstrual health services and counseling, 3- cultural taboos and beliefs in the community 4- modifying poor management attitude, and 5- self-neglect. The findings showed that menstrual hygiene needs of women in affected areas are exacerbated by indigenous beliefs and low self-care skills and remain unchanged due to the lack of appropriate health services and efficient management system. Therefore, identifying women’s needs for menstrual hygiene is crucial in crises.

Background and Diabetes is the most common metabolic disease in the world. Previous studies have reported that the strict control of blood sugar prevents or delays the development of diabetes-related complications. The most important factor to control the disease is self-care. The purpose of this study was to evaluate the effect of variables like duration of diabetes, central obesity and diabetes knowledge on the self-care behaviors The present study is cross-sectional. 500 out of 752 diabetic patients were selected using stratified random sampling. Measures of data collection were questionnaires containing demographic information, self-care and diabetes knowledge. Frequency tables, χ2 tests, independent T test and ANOVA were used to examine the relationship between demographic characteristics and self-care. Also, the multiple-linear-regression was used to predict the affecting factors on the self-care. 464 patients participated in the study of 500 patients selected (respose rate 92/8%). The mean score of self-care behavior in patients with diabetes was 3.77±1.15. There was a significant association between the self -care and parameters like duration (p= 0.013), type of treatment (p= 0.035) and central obesity (p= 0.046). Diabetes knowledge(B= -0.123) after Duration of diabetes(B= 0.170) was the strongest predictor of the self-care behavior. In addition to affecting demographic factors, the role of factors such as Diabetes knowledge in promoting self-care behaviors in patients with type II diabetes cannot be ignored. Based on these results, it is necessary to emphasize on the importance of promoting Diabetes knowledge by health workers and doctors.

Background and Allergic rhinitis is one of the most common allergic diseases with increasing incidence worldwide. It influences the hygienic and economic situation, thereby life quality of patients. Identification and characterization of aeroallergens patterns in each region, as one of the main causes of allergic rhinitis development, is an essential step in preventing and controlling the disease. The purpose of this study was to determine the prevalence of aeroallergens in patients with allergic rhinitis in Tehran. In a cross-sectional study 400 asthmatic patients attending Khorshid Allergy and Immunology Clinic in Tehran (January 2013 to 2014) were recruited. Patient information was recorded and those with allergic rhinitis have been identified. Their sensitivity to 12 common allergen extracts was determined by skin prick test. SPSS V.20 was applied for data analysis. The prevalence of allergic rhinitis was 40% (n= 165) with similar ratio between males and females. All patients were susceptible to at least one allergen, and 1.3% was completely susceptible to all allergens. The most frequent positive skin reaction was due to outdoor allergens (20.54%) i.e. pollen. Indoor allergens included mites (66.46%), hair and skin of animals (78.18%), and fungi (37.17%). Indoor and outdoor aeroallergens were more prevalent in 1-6 year- old children, and 7 year and older, respectively. We observed a high prevalence of allergic rhinitis which was similar to the global statistics. This calls for identifying the causative factors, thereby developing measures to control and prevent severe allergic outcomes in patients.

Background and A clear agreement is doubted in identifying vaginismus based on the clinical diagnostic criteria including pain, cramps and spasms. This study was performed to design a diagnostic questionnaire for vaginismus and investigating its psychometric characteristics. This study was performed with a combinatorial approach. The final questionnaire was approved after performing 33 interviews and applying professional expertise in the qualitative part. In first stage of the quantitative part in face validity, the questionnaire was completed by 30 participants and its content validity was studied by 11 people from expert panel. Finally the validity was calculated by asking 100 patients. The internal and external validity were determined using Cronbach's alpha and test-retest in 30 patients with pain during examination. At first, the changes in the qualitative stage of face validity was applied and the item effect index for 6 items were lower than 1.5 in the quantitative stage of face validity. Five questions did not receive desired points in CVR and CVI calculation in the quantitative part of content validity. KMO rate was 0.810 in the qualitative factor analysis. Also, the Bartlett's test of significance level was less than 5 percent. Cronbach alpha rate was calculated as 0.907. The external reliability was lower than 0.05. This instrument contains low number of questions, simple items to answer and is both reliable and valid, so it could be used for proper diagnosis of vaginismus in women with pain during sexual intercourse.

Background and Urinary tract infection (UTI) is one of the most common and the most important clinical problems in patients with diabetes mellitus. In asymptomatic form it could cause symptomatic UTI and sepsis. There is controversy over the prevalence and risk factors of asymptomatic UTI. This study was conducted to determine the prevalence of asymptomatic UTI in diabetic patients attending Imam Khomeini Hospital in Sari. This cross sectional study included 349 diabetic patients referring Diabetes Clinic in Imam Khomeini Hospital without symptoms of UTI. Urine analysis and urine culture were performed and data was collected including demographic characteristics, duration of disease, FBS, 2hrpp, and number of WBC bacteria in urine. The patients were 92 male (26.36%) and 257 (73.63%) female and asymptomatic UTI was observed in 16.9% (n= 59 patients). Its prevalence was 13.04% in male and 18.28% in female. According to the results prevalence of asymptomatic UTI was high in patients with long duration of disease, poor control of diabetes, high number of WBC and bacteria in urine.

Background and Follicular atresia is a natural phenomenon throughout growth and development, but in excessive cases it causes disorders in the ovarian function which is the commonest cause of infertility. Outbreak of depression in women is twice as much as men. Electric-shock therapy could be used in the treatment of depression resistant to drugs. However, it has some side-effects. This research was conducted to study the effects of electric shock on ovarian follicular atresia. In this experimental study, 70 albino mice weighing 28±1.5g (9-12 weeks) with normal sex cycle were divided into 15 groups (n= 5 per group) after determining estrous cycle stages by vaginal smear. The mice were allocated into four control groups in four estrous cycle stages, four groups receiving one shock in every four stages, four groups receiving two- shocks (with interval of 4 hours) in each stage of sex cycle and two shock groups in all phases of the cycle with one and two shocks, respectively. The shock was given by a laboratory electric shock device and was tolerable for mice. The samples of ovarian tissues were stained with hematoxylin-eosin. The follicles were then examined and counted by scaled lens of a light microscope. In proestrus stage of sex cycle, a significant difference was seen between the one-shock group and other groups in mean rate of follicular atresia. This study indicated that receiving shock leads to an increase in the mean rate of atretic follicles and the most negative effect was observed in the one-shock group in proestrus phase.

Background and Gestational diabetes is known as increasing blood glucose level for the first time during pregnancy. Mitochondrial damage and oxidative stress are the most important factors in the development of diabetic complications. Cerium nanoparticles have antioxidant properties. In this study we examined the protective effect of nanoceria in preventing mitochondrial damage induced by diabetes. In this study, the mice were divided into five groups including control, diabetic, Nanoceria, diabetes+Nanoceria, and diabetes + vit E groups. Diabetes was induced by STZ (60 mg/kg IP). Blood glucose level was checked in days 1,5,10, and 15 of pregnancy. The diabetic state was confirmed when the blood glucose concentration exceeded 200 mg/dl. On day 16 of pregnancy the embryos were excised and their mitochondria were isolated using different centrifuge technique. Then, oxidative stress markers and mitochondrial damage were measured. Diabetes significantly increased the production of reactive oxygen species, lipid peroxidation and oxidation of glutathione in isolated mitochondrial in embryo of diabetic mothers (P<0.05). Nanoceria treatment (60 mg/kg) significantly prevented the mitochondrial oxidative stress induced by gestational diabetes in embryo of mice (P<0.05). Also, mitochondrial function significantly decreased in diabetic group compared to that of the control group, which was caused by nanoceria treatment that significantly inhibited diabetes-induce mitochondrial toxicity (P<0.05). Cerium oxide nanoparticles had significant effects in preventing oxidative stress and mitochondrial damage induced by gestational diabetes and could be considered in reducing the effects of gestational diabetes.

Background and Sand flies are widespread in Iran and are vectors of leishmaniasis and pappatci fever in most parts of the country including Southern Khorasan Province. Faunistic and ecological studies of these flies are necessary in order to implement proper vector control programs. This research was conducted to determine the sand flies fauna in Southern Khorasan province. Sand fly specimens were collected from seven cities in Southern Khorasan province during May to August 2012 using sticky paper traps. The specimens were identified and their monthly activity and frequency in the province were measured. In this study, a total of 1294 insect specimens was collected of which 171 sand flies were identified. Species belonged to Phlebotomus and Sergentomyia genera including four species: Phlebotomus sergenti s.l., Ph. papatasi, Sergentomyia sintoni and S. dentata. Phlebotomus sergenti s.l. was the dominant species in this study which is also the main vector of cutaneous leishmaniasis in Iran. The most and the least abundances were observed in Darmian (29.2%) and Boshrooye cities (1%), respectively. According to the results, two vectors of cutaneous leishmaniasis were found to be active in studied area. Ph. sergenti s.l. was the dominant species in all study areas with relatively high frequency especially in July. Therefore, the health system of the province should be aware of the potential of anthroponotic cutaneous leishmaniasis (ACL) in these areas.

Background and Radiographs are essential for detecting proximal caries. The aim of this study was to compare proximal caries detection using intra oral bitewing with film and digital bitewing. Digital bitewing and conventional bitewing radiographs were taken from 100 extracted human teeth. Proximal caries depths in radiographs were scored by two oral and maxillofacial radiologists. Then the teeth were sectioned to evaluate and score the depth of caries lesions in proximal surfaces under microscope. Scores of radiographic and histopathologic assessments were compared using ROC curve analysis. The differences of sensitivity and specificity of two techniques were not statistically significant. Accuracy of both radiographic techniques was found to be similar in this study.

Background and This aim study was to compare the level of sensation seeking among sex addicts, stimulants addicts, Opioid addicts and normal groups. Design of our study was Causal-comparative. Subjects were selected with using purposive sampling method (28 cases of sexual addicts, 34 case with Opioid addiction, 30 case with addiction to stimulants and 30 normal subjects). Data gathered from the sensation seeking questionnaire. The results showed that the groups were significant differences in the levels of sensation seeking general and Subscales sensation seeking. According to the findings, people with different type of addiction has been associated with different levels of sensation seeking.This findings revealed necessity more attention to interventions focused on sensation seeking Based type of addiction.

Background and Suitable diets during adolescence are effective in providing nutritional needs, and allowing physical and mental growth in adolescents, and in preventing chronic diseases in adulthood. Some studies suggest a relationship between nutritional status and composition of blood lipids. This study was designed to investigate the association between intake of different food groups and composition of blood lipids in adolescents. In this descriptive-analytic study, 312 adolescents aged 10-18 years old were selected using random cluster sampling in 2011. Nutritional and biochemical information was collected for all participants and analyzed using SPSS V. 16. The mean age of the subjects was 15.07±2.42 years and there were 51% female and 49% male. Significant correlation was found between intake of bread and cereals (P=0.001), milk and dairy products (P=0.047), and vegetable groups (P=0.021) with HDL cholesterol levels in adolescents. According to this study nutritional status of the studied adolescents should be improved. Paying more attention to quality and variety of dietary intake could have important effects on modifying the risk factors for various diseases in this age group.

Langerhans Cell Disease (LCD), formerly known as Histiocytosis X, is a rare disorder characterized by a proliferation of cells exhibiting phenotypic characteristics of langerhans cells. The etiology and pathogenesis of this disease is unknown. It can occur as focal or disseminated form-acute or chronic. Oral manifestations may be the first signs. In this report a 2-year old boy is presented. He referred with a chief complaint of luxation of posterior teeth of right side of mandible. In panoramic radiography, resorption of alveolar bone was observed in posterior side of mandible. Complete examinations were performed for the patient. No other part of the body was found to be affected by the disease. Early diagnosis and treatment of this disease is important in the prognosis, therefore, dentists should be aware of oral manifestations and differential diagnosis of this disease.

Aphallia or complete absence of penis is an extremely rare genitourinary anomaly derived from a faulty development of the genital tubercle during embryonic life. It usually coexists with other congenital anomalies. This anomaly has a very significant psychosocial impact on the child and parents. We describe herewith a neonate with male genotype who presented with aphallia and multiple anomalies of musculoskeletal and genitourinary system.

Thyroid carcinoma is the most common endocrine neoplasia. Like other cancers, early detection of thyroid cancer plays an important role in the treatment and prevention of disease progression. In recent years many efforts have been made to detect molecular biomarkers for early prediction, diagnosis, and prognosis of different types of cancers. This article is a review on different researches about biomarkers of thyroid cancers. Original articles published (between 1996 and 2015) about biomarkers and thyroid cancers were identified by searching different databases. According to different types of thyroid cancers, the articles were reviewed in different four sections. In most cases FNA could determine the nature of thyroid nodules. However, this method is faced with some limitations especially in detection of lesions associated with follicular thyroid cells. To optimize the accuracy of diagnosis and to offer new prognostic criteria, several immunohistochemical and molecular markers have been proposed which should be verified before clinical application. In spite of large volumes of data about discovery of different biomarkers for thyroid cancers, few of them could be used in clinical applications. In many cases using each of these molecules alone may not be useful, therefore, combination of two or more biomarkers could be of great help in diagnosis, prognosis and prediction of thyroid cancer.