مجله دانشگاه علوم پزشکی مازندران
پیاپی 129 (مهر 1394)

Background and Patients with Beta thalassemia major need consistent blood transfusion from early years of life. Deferasirox is used as an oral chelating agent (once daily) to excrete excess iron. This study aimed to compare the efficacy of deferasirox twice daily and the usual once daily dosing. This before after clinical trial was performed in 2013-2014 in patients who were at least 2 years of age and received only deferasirox as the chelating agent. All patients had received deferasirox for at least six month once daily. The last ferritin before entering the study and the mean deferasirox daily dose during the previous six months were considered as baseline ferritin and deferasirox dose, respectively. Laboratory tests were performed including CBC-diff, serum ferritin, Creatinine (Cr), Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) to evaluate the efficacy and safety of deferasirox. A total of 21 transfusion-dependent patients (mean age: 21±6 years old) were included of whom 67% were male. The mean ferritin level decreased significantly from 1814± 922 ng/ml to 1472± 907 ng/ml (P= 0.02). There were no any significant changes in AST, ALT and Cr levels compared to baseline values. Twice daily dosing of deferasirox was associated with more decrease in ferritin level compared to baseline single daily dose values without any hepatic or renal adverse effects.

Background and Ischemic Heart Disease (IHD) is one of the most important complications of diabetes mellitus (DM). This study was designed to investigate the prevalence of IHD and related factors in patients with type II DM in north of Iran. A cross sectional study was conducted in 1021 patients with diabetes type II attending endocrine clinics affiliated with Mazandaran University of Medical Sciences, Iran, 2010 to 2012. Age, gender, history of myocardial infarction, hypertension, hyperlipidemia, smoking and other recognized complications of DM were recorded. All patients were referred to cardiologist and the exercise test was used and if needed the thallium perfusion scan and coronary angiography were done for patients without history of myocardial infarction,coronary artery bypass surgery or stent placement. There were 1021 patients and 907 were female (88.8%). Mean age and duration of diabetes were 54.4 (95% CI: 53.8- 55.1) and 8.8 (95% CI: 8.4 - 9.2) years, respectively. Almost 87% (95% CI: 85-89) and 53% (95% CI: 50-56) had dyslipidemia and hypertension, respectively. Among the patients, 274 patients (37% males and 25% females, 26.8%; 95% CI: 24.1-29.5) were suffering from IHD (P =0.006). According to regression logistic analysis duration of diabetes, older age, hypertension, and low left ventricular ejection fraction were independent predictor factors for IHD. Approximately one-third of diabetic patients are suffering from IHD. This disorder can be asymptomatic in individuals with diabetes, therefore, it may not be diagnosed in almost half of patients. Most important associated factors are older age, duration of diabetes, hypertension and low left ventricular ejection fraction.

Background and Vascular calcification is an important factor in pathogenesis of atherosclerosis. Studies have shown that alkaline phosphatase increases vascular calcification. Here we investigated the effect of gallic acid on alkaline phosphatase gene expression in vascular smooth muscle cells (VSMCs). In this experimental study humans aorta VSMCs were incubated with beta glycerol phosphate as calcification-inducing media. Then these cells were treated with 160, 180 and 200 µMol concentration of gallic acid for 24h, 48h and 72h. The total RNA was extracted and cDNA was synthesized and then alkaline phosphatase expression was measured by real time PCR. Alkaline phosphatase specific activity was measured by spectrophotometry. Overall, 160, 180 and 200 µMol concentration of gallic acid decreased alkaline phosphatase gene expression in vascular smooth muscle cell by 1.98, 2.03, and 3.16 folds, respectively after 72h compared with the control group. The alkaline phosphatase specific activity also decreased compared to that of the control group. Our results showed that gallic acid decreased the expression and activity of alkaline phosphatase suggesting that this antioxidant compound may attenuate vascular calcification.

Background and Kidney failure reduces the kidney function and in long term it leads to chronic kidney disease. One of the main complications of this disease is irreversible damage to the kidneys (end-stage kidney disease) and hemodialysis is the main method used to treat advanced kidney failure. The main problem associated with hemodialysis is treating anemia caused by lack of erythropoietin secretion in kidney which is usually treated by synthetic erythropoietin. On the other hand, choosing the right dosage of erythropoietin is important because it is expensive and could have some complications. This research aimed at predicting the dosage of erythropoietin and identifying affecting factors. Data was collected from a dialysis center in Tehran and data mining methods were used. The input variables were measured in the past 6 months of treating patients with erythropoietin. The sequential data was then converted to the bag of features (BOF) format. Then support vector machines and random forest were applied on the BOF to predict the erythropoietin dosage. The amount of medication in previous months was found to be an important factor in determining the appropriate dosage of erythropoietin for the next month. In optimal condition, random forest and SVM could predict the erythropoietin dosage with an average accuracy of 90% and 79%, respectively. This study identified the factors influencing the treatment and control of anemia in hemodialysis patients. These results could be of great benefit in prescribing the proper dosage of erythropoietin, and reducing the treatment cost and duration. Moreover, it helps to prevent the complications caused by excessive use of erythropoietin such as increase in hemoglobin level.

Background and Escherichia Coli is one of the most common pathogens associated with nosocomial infection. Increasing use of beta Lactam Antibiotics in treatment of bacterial infections resulted in increments of drug resistance of such bacteria that is caused due to the production of B-lactamase enzymes. The beta lactamase – producing bacteria especially E.coli which is resistant to beta lactam antibiotics may pose great risks for patients. This study was conducted to determine the prevalence of CTX B-lactamase in E.coli isolates collected from hospitals in sari and Qaemshaher, Iran. In this study, 200 urine samples were collected from nephrology and infection departments in Qaemshaher Razi and Sari Imam Khomeini hospitals. The samples were cultured on EMB agar and incubated at 37oC for 24 hours. E.coli isolates were detected in 120 samples using standard bio chemical tests. ESBL production was determined by combination disk method. Then, the susceptibility of isolates towards antibiotics was determined by standard disk diffusion method. The presence of CTX gene was determined applying PCR. From 120 samples identified as Ecoli 66 (55%) were ESBLs producing strains. PCR showed that from 66 isolates 40 (60%) contained CTX gene. Our study showed high frequency of CTX gene in ESBL producing isolates. This indicates the role of enzyme in resistance to beta lactam containing antibiotics. This issue poses a serious harm to public and all necessary actions should be taken to prevent and control this problem.

Background and Lavender is a medicinal plant with antioxidant activity. Stroke causes long term disability and is associated with oxidative stress. The present study was conducted to evaluate the protective effect of lavender extract against blood brain barrier permeability and its possible mechanisms in an experimental model of stroke. In this experimental study, 42 male Wistar rats weighing 250 to 300 g were used. The rats were divided into 6 groups (n= 7 per group). Group 1 was ischemic, groups 2 and 3 were ischemic that were given 100 and 200 mg/kg lavender extract, respectively. Group 4 were intact and groups 5 and 6 were intact groups which received lavender extract with dose of 100 and 200 mg/kg. Group 7 was also considered as the sham. Focal cerebral ischemia was induced in rats by the transient occlusion of the middle cerebral artery for 1 hr. Data were analysed with SPSS and comparison of means were compared using One Way Anova. The ethanolic extract of lavender at 200 mg/kg significantly reduced the blood brain barrier permeability in rat stroke model compared with ischemic group. The results indicate that lavender extract has neuroprotective activity against cerebral ischemia and alleviated neurological function in rats.

Background and Endometriosis is a chronic and debilitating disease which is associated with a variety of morbid symptoms. This study aimed at exploring the perception and experiences of patients with endometriosis about pain. A qualitative research was performed in 18 patients with endometriosis attending Arash Hospital (Tehran, 2014). They were selected by purposive sampling. Data was collected by semi-structured interview and analyzed using a conventional content analysis. Two main themes emerged from the participant's experiences: 1) disruption of individual and family life and 2) feelings of threat and vulnerability. The first theme included two categories: suffering varied and diffused pain and disruption of sexual activity. Categories of the second theme were: complaints of severe and intolerable pain and various actions taken to reduce the pain. The findings suggest that patients with endometriosis suffer various pains that influence different parts of the body. These pains are often felt with great intensity and may have devastating consequences on their lives. Deep attention should be paied to the symptoms of these patients and health authorities should not trivialize their pain so that early diagnosis is made and suitable interventions are performed to promote such patients’ health.

Background and Bombesin shows very high-affinity for the Gasterin releasing peptide (GRP) receptors which are over expressed in different human tumors such as breast and prostate. The aim of this study was to identify a new bombesin derivative labeled with 99mTc via HYNIC that might be used as a noninvasive tool for diagnosis of GRP receptor expressing tumors. Prepared bombein derivatives were radiolabeled with 99mTc at 100 °C for 10 min by exchange method and radiochemical analysis was performed using ITLC and HPLC methods. The stability of radiopeptide was checked in the presence of human serum at 37 °C and saline for up to 24 h. [99mTc-EDDA/tricin/HYNIC-(Ser)3-D-Phe13]BN(7-14) and [99mTc-EDDA/tricin/ HYNIC-(Gly)3-D-Phe13]BN (7-14) were obtained with radiochemical purities of >95%. Results of in-vitro studies demonstrated a high stability in serum and saline. Radiolabeling of this novel conjugates with 99mTc were easily performed using exchange labeling. The prepared 99mTc-HYNIC-BN conjugates demonstrated some potential as site-directed diagnostic radiopharmaceuticals. Therefore, more in vivo studies are required.

Background and Diabetic foot infections are the most common problems that result in disability and hospitalization of diabetic patients. Preventive measures can decrease the incidence of diabetes and its complications thereby, reducing the economic cost of associated health services. The aim of this study was to evaluate the prevalence of predisposing factors in diabetic foot ulcer infection and the frequency of different clinical outcomes and their relationships with predisposing factors. This analytical study was done in 200 hospitalized patients with diabetic foot infection in Sari teaching hospitals, 2013-14. Patients were evaluated for symptoms and signs of ulcer infection, neuropathy and vasculopathy. Also, demographic characteristics of all participants were recorded. Data was analysed in SPSS V.16. The patients were 54% male and 46% female (mean age 58.3+10.2 years). Amputation was performed in 20.5% of the patients of whom 75% were male. The most common location of diabetic foot ulcer was the hallux and ankle was the least infected location. All the cultures were positive and the most prevalent pathogens were staphylococcus aureus (28%) and Pseudomonas aeruginosa (14.5%).The results showed that previous history of ulcers and amputation and osteomyelitic changes in foot X-ray could predict risk of amputation. Diabetes is so prevalent in Iran, therefore, it is important to reduce the incidence of diabetes complications by providing appropriate training to the patients, their families and healthcare staff.

Background and Resistance to antibiotics has decreases the performance of antibiotics and has dramatically increased over the past few years. This has led to increasing interest towards discovery and introduction of new antibiotic compounds, especially plant-derived compounds. The aim of this study was to investigate the antibacterial activity of the methanol extracts from different parts of Prangos crossoptera against pathogenic bacteria and their drug synergistic and antagonistic with standard antibiotics. Antibacterial activity of methanol extracts from different parts of Prangos crossoptera was investigated against Proteus mirabilis, Proteus vulgaris, Streptococcus sobrinus, and Staphylococcus saprophyticus in 250 to 3000 µg/ml concentrations by disc diffusion and micro-broth dilution methods. Then, the MIC and MBC values and inhibition zone of all extracts were measured. The synergistic effects of the most efficient concentration were studied on four common antibiotics. All tested extracts, especially the flower, exhibited significant antibacterial activity against studied bacteria. The flower extract also showed synergistic effect on penicillin and ampicillin activity but did not influence the performance of gentamicin and streptomycin. The P.crossoptera has significant antibacterial effect and could increase the activity of penicillin and ampicillin.

Background and Mothers’ depression is considered as a risk factor for children’s cognitive and social-emotional development that could lead to behavioral, emotional and cognitive disorders. Sleep behaviors and patterns could be influenced by mothers’ depression. This research aimed at investigating the relationship between mothers’ depression and sleep problems in their 3-6 year old children. This causal-comparative study was conducted in 3-6-year old preschool children and their mothers in the cities of Urmia and Mahabad. Applying cluster sampling, 465 mothers were selected and completed the Beck Depression Inventory (BDI) and the Sleep Disturbance Scale for Children. Mothers were divided into six groups based on their BDI scores. One way ANOVA and Pearson correlation test were used for data analysis. The findings indicated a significant positive relationship between different components and total scores for depression and sleep problems (P>0.001). ANOVA analysis showed significant correlation between level of depression and different types of sleep disorders in children. In other words, children of mothers with more levels of depression suffered more sleeping problems (P> 0.001). Mothers’ depression and psychological problems disrupt the children’s normal sleep, thereby causing other problems. So, it is necessary to focus more on controlling depression to avoid its negative influences on the health of family and children.

Background and Clindamycin is used in treatment of common infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Constitutive or inducible resistance of clindamycin are important factors in choosing that as an effective antibiotic. The aims of this study were to determine inducible resistance clindamycin and analysis of multiple antibiotic resistance profile in clinical isolates of MRSA. Identification of 250 clinical Staphylococcus aureus isolates was carried out using biochemical and molecular methods. After determining the sensitivity to erythromycin, constitutive or inducible clindamycin resistance were detected by D test according to CLSI guidelines. Out of 250 clinical Staphylococcus aureus isolates, 130 isolates (52%) were resistant to methicillin. Among them, 118 isolates (90.8%) were resistant to erythromycin. Moreover, 105 (88.9%), 9(7.6%) and 4 (3.3%) isolates were identified as constitutive and inducible resistance to clindamycin and MS phenotype, respectively. Inappropriate antibiotic therapy in MRSA infections leads to development of constitutive resistance and treatment failure. Also, due to increasing constitutive resistance in MRSA isolates, performing D test is essential to distinguish the constitutive and inducible resistance and selecting the best treatment.

Background and Scabies is caused by a mite called Sarcoptes scabiei and can be spread from person to person through skin contact. In this study, we have analyzed the effect of Malathion lotion 0.5% and compared that with the effect of Permethrin cream 0.5%. In a randomized clinical trial 60 patients were divided into two groups to receive either Permethrin cream 5% or Malathion lotion 0.5%. Both groups were monitored every two weeks for one month. The qualitative data of both groups were compared using student t-test and chi-square test was applied to analyze the qualitative data. There was no significant difference between the two groups in number of lesions at the begging of the study (P=0.1503). Also, no significant difference was seen in weeks two and four. But Malathion lotion was found to be more efficient than Permethrin (P=0.0163) in reducing the number of lesions; although the results were better in week four, but the difference was not significant (P=0.2940). This study showed high efficacy of Malathion 5% in treating scabies.

Background and Every stage in preparation of blood and blood components, storage, transportation, and transfusion involves a specific process which should be continuously supervised. The aim of this study was to compare the knowledge of resident physicians, interns and nurses about transfusion medicine in 2013. In a descriptive cross-sectional study, 147 individuals were randomly selected from resident physicians, interns and nurses in Imam Khomeini, Boali sina, Zare and Fatemehzahra hospitals in Sari. A questionnaire containing twenty questions was used to assess their knowledge and practice about transfusion medicine. Their scores were classified into three levels (poor, average, and good). The highest score for knowledge was achieved by residents (mean score: 6.2) while nurses had the highest score for practice (mean score: 38.2) which was significantly higher than other groups (P=0.00). This study showed that nurses and medical students including residents and interns require more training about blood transfusion medicine.

Background and

Albumin colloid is an expensive drug that is used unnecessarily in many cases.The purpose of this study was to review the rational use of human albumin in a teaching hospital.

This retrospective study was conducted in Razi Hospital in Qaemshahr, Iran 2011. Demographic and clinical data was recorded and the appropriateness of albumin use was determined according to ASHP protocol.

There were 100 patients receiving albumin and in 14% the serum albumin was not measured before or during the treatment. The median administration of albumin was 60 gr per patient. The reasons for starting human albumin were reduced serum albumin (56%), reduced blood volume (18%), and sepsis infection (9%). The use of albumin was appropriate in 63% of the patients.

The irrational use of albumin imposed 146 million Rials additional cost. Treatment according to standard guidelines could promote rational use of medicines and cause more saving in health costs.

Background and Tuberculosis (TB) is created by Mycobacterium tuberculosis. Application of Geographical Information System (GIS) is of great benefit in understanding the geographical pattern of TB and strengthens its control programs. This study was performed in Guilan, Iran to determine the geographical pattern of TB in this province. The present ecological study was performed in 3027 TB patients in Guilan province in 2005-2011. Data was collected using complete enumeration and the maps were drawn by ArcGIS V.10. Among the cases 2152 (71.1%) had pulmonary tuberculosis and 875 patients (28.9%) had extra pulmonary tuberculosis. In the maps of county and villages, the highest average of 7-year incidence was observed in Siahkal. In our study GIS maps indicate a specific pattern in incidence of tuberculosis.

Background and Since long time ago disposal of expired and unused medicines from homes and pharmacies has been regarded as an important issue. These types of drugs have terrible effects on human health and environment. This study investigated the methods for disposal of pharmaceutical waste from pharmacies and homes. In a descriptive study, 30 pharmacies and 100 patients’ homes were randomly selected in Shiraz, Iran. A questionnaire about the storage and disposal methods of expired and unused medications were then completed. The results showed that patients did not have enough information about disposal methods of expired and unused medicines, but in pharmacies these drugs were sorted in particular labeled packaging and kept in separate places. According to this study disposal of expired and unused drugs are not performed according to official instructions.

Fetal cholelithiasis is rare during pregnancy. Ultrasound examination in third trimester is the best diagnostic modality for detection of this condition. We report a case of 30- year old pregnant woman, at 36 weeks gestation, attending medical imaging center for routine obstetric ultrasound examination. Diagnosis of gallstones was made based on presence of multiple echogenic foci in the fetal gallbladder lumen. The expectant mother had a normal pregnancy. She received one dexamethasone injection and one Gelofen soft gelatin capsule. The parents did not have consanguineous marriage. Also, they did not have any specific disease such as anemia or other diseases.

Endometriosis is a painful chronic disorder in premenopausal period that causes severe pelvic pain. It could be problematic for both the patient and physician since routine analgesic drugs may not resolve the symptoms. Therefore, various destructive surgical treatments are used in these patients and presacral neurectomy is one of the best and most recommended surgical methods. This paper reports pre sacral neurectomy operation that was performed in Sari Imam Khomeini Hospital for the first time on a 31-year-old woman suffering from severe mid pelvic pain. She was resistant to treatment but favorable results were observed after the operation.

Conidia of Aspergillus species are widely distributed and ubiquitous in outdoor and hospital environments. There are high numbers of patients with weakened immune systems, therefore Aspergillus infections are increasing in hospitals. Molecular typing of Aspergillus strains obtained from patients and their environment is an important tool for epidemiological and public health studies. Fingerprinting for Aspergillus species especially fumigatus and flavus adjusted from respiratory samples and environment requires high quality typing methods. In recent years several molecular typing methods have been established for different Aspergillus species. These methods are more useful than conventional methods and are of great importance due to being more practically accessible, easy to use, having high ability in diagnosis, repeatable and sensitive to change in one laboratory and between different laboratories, and easy interpretation of data. Today accurate typing methods include Multilocus Sequence Typing (MLST) and micro satellites. In ccurrent review different molecular methods for Aspergillus species genotyping are discussed to obtain a better insight into epidemiology of this pathogen.