مجله دانشگاه علوم پزشکی گرگان
سال بیستم شماره 4 (پیاپی 68، زمستان 1397)

Multiple sclerosis (MS) is a chronic and multiphasic autoimmune disease which affecting the nervous system. Recently, neurotrophic factor secreting cells have been proposed as one of the best sources for cell therapy in MS disease. Therefore, this review study was done with aimed to introduce neurotrophic factor secreting cells and the role of neurotrophic factors in the treatment of MS. The present study, based on the Systematic Review and using multiple sclerosis, neurotrophin and cell therapy keywords, 98 articles were searched from various databases including Pubmed, SID, Springer, SinceDirect Magiran, Web of Sciences and the Google Scholar. After removing irrelevant and repetitive articles, 50 articles were selected. The results of these studies showed that cell-based therapies in MS have been designed with the aim of replacing destroyed cells or with the goal of neuronal support using neural growth factors. Neurotrophic factors secreting cells with the ability to migrate to neurological lesions and secretion of neurotrophic factors can play a major role in supporting neural tissue and preventing its destruction. These factors, through tyrosine kinase receptors, have a variety of effects on the development and proper functioning of neurons. On conclusion, neurotrophic factor secreting cells due to the secretion of a wide range of neural growth factors which required for neural development might be one of the ideal cell sources for cell-based therapy in MS disease.

The kangaroo care method in newborn is a way of protecting the baby through skin to skin contact between newborn and their parents. This review study was done by using the keywords including kangaroo mothre care, neonatal, skin to skin contact and preterm. All related articles were published in Pubmed, Sience direct, Google scholar, SID, and Magiran were studied during 2000 to 2016. Finally, 36 articles were reviewed which were similar according to objectives, method of work, sample size, analysis method, and conclusion. Reviewing the selected articles showed that skin to skin contact among newborn and their parents regulated the body temperature of the neonate, increased the newborn's immune system, reduced infection and mortality rate, regulated heart and respiratory rate, increased the growth and weight gain in low birth weight neonates, reduced the stress and crying, increased prolong and stable periods of sleep, and also creates an emotional bond between the parents and the neonates. Kangaroo care method not only helps to care for the early stages of growth of premature neonate, but also increases the general health of the newborn and mother. This care can be used as an inexpensive and highly beneficial method for neonate's growth and health in human.

Electro convulsion therapy (ECT) is one of the most common ways for treatment of psychiatric disorders. The aim of this study was to compare the effect of Propofol, Etomidate, and Thiopental on seizure and recovery duration following ECT. In this clinical trial study, 90 patients diagnosed with a psychiatric disorder by a psychiatrist, who need to be treated by ECT in 5 Azar hospital, Gorgan, north Iran. The patients were randomly divided into the three groups by simple random allocation method. Interventions included standard monitoring and pre-oxygenation with 100% FiO2 for 3 minutes for all patients in three groups. Anesthesia of the patients in the first, second, and third group was done with Thiopental (1.5 mg/kg), Propofol (0.6 mg/kg), and Etomidate (0.1 mg/kg), respectively. Administration of Succinyl Colin (0.5 mg/kg) as muscle relaxant and Atropine for prevention of bradycardia was uesd in all patients. Duration of seizure and recovery; changes in hemodynamic status including heart rate (HR) and mean arterial pressure (MAP); and amount of charge for ECT were recorded for each subject. Mean of seizure duration in Thiopental, Propofol, and Etomidate groups were 43.72±11.81, 35.74±10.58 and 45.81±17.26 seconds, respectively (P<0.05). Amount of charge for ECT in 3 sessions of treatment and changes of HR were not different between the 3 groups. Changes of MAP in the Propofol group was significantly less than other two groups (P<0.05). Recovery time following ECT was the least in Etomidate group in comparison with Thiopental and Propofol (P<0.05). Ethomidate and Thiopental had the same effect on increasing seizure duration. However, due to the significant reduction in recovery time compared with Thiopental, Ethomidate may be considered as the best choice.

Life style with Low activity and overweight increased the risk of cardiovascular diseases. This study was done to evaluate the effect of ginger supplementation on Lactate dehydrogenase (LDH) changes and delayed muscle soreness following exhaustive eccentric exercise on overweight girls. In this randomized clinical trial study, 22 overweight girls were randomly divided into the two groups including intervention (n=12) and control (n=10) groups. For subjects in interventional group were used a daily supplement of 2 grams of ginger powder, each serving a capsule, containing one gram of ginger powder and subjects in control group were received daily two capsules containing starch, for two weeks. Physical activity was performed consisting of two sessions of exhausting activity (negative tilt on treadmill, one session before supplementation and one session after two weeks of supplementation). Blood samples were measured in order to measure changes in LDH in four stages and the use of the pain questionnaire for evaluation of delayed muscular brittleness in both pre and post gingival supplementation. Pain scale (visual analogue scale: VAS) was used to measure the delay fatigue. The results showed that extrinsic exercise increased LDH and delayed muscle soreness after exercise (P<0.05). Also, taking two weeks of ginger supplementation significantly reduced LDH and delayed muscle soreness in the supplement group in comparison with controls (P<0.05). Ginger can reduces the muscle gain and delayed onset muscle soreness resulting from eccentric exercise in overweight girls.

  Gestational diabetes (GDM) is a metabolic disorder which is caused by insufficient secretion of insulin. GDM is a risk factor for embryo during pregnancy and it is possible leads to congenital heart defects (CHD). Some of these defects may be due to a change in the expression of some of the important structural genes in the heart. Desmocollin 2 and collagen structural genes have important role in the cell adhesion of the cardiomyocytes.This study was done to determine the effect of gestational diabetes on expersion of desmocollin 2 and col5a2 structural genes in C57BL mouse embryo heart. In this experimental study, 12 adult female and six adult male C57BL mice were used.After mating of the animals and observation of the vaginal plug, the female mice with vaginal plug were randomly divided into diabetic and control groups. At the first day of pregnancy, Induction of gestational diabetes mellitus in dams in the diabetic group was performed by the intraperitoneal (IP) injection of Streptozotocin with a dose of 150 mg / kg body weight per day in GD1. While in the control group, only citrate buffer was injected.Cesarean Surgery was done at E11.5 and embryo's heart was extracted from the body.Extraction of RNA, cDNA, and quantitative measurements of the amount of RNA were performed using Real -Time PCR. Induction of gestational diabetes increased the expersion of desmocollin 2 and col5a2 structural genes in compared to controls, althought only the expersion of desmocollin 2 gene was significant (P<0.05). We suggest that the induction of DM lead to upregulation of structural genes primarily including desmocollin 2 and col5a2 in embryos heart development.

Multiwall carbon nanotubes nowadays have multiple uses in the field of drug and gene delivery and other biological fields, and it is necessary to study their potential toxicity on organisms due to unique properties of these nanostructures. This study was conducted to determine the toxicity of multi-wall carbon nanotubes functionalized with carboxylic groups on the function and structure of the rats liver tissue. In this experimental study, 50 mature female Wistar Rats were randomly allocated into five groups including the control group of normal saline and Tween and treatment groups 2.5, 5, 10, 20 mg/kg/bw concentrations of multi-wall carbon nanotubes functionalized with carboxylic group with diameter less than 8 nm and length 30 micrometers that was received in 8 steps, intraperitoneally. Blood sampling was performed in two steps (The first stage was one day after the last injection and the second stage was 20 days after the last injection). The level of activity of the aspartate aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP) enzymes and the amount of malondialdehyde were measured in serum. By preparing the tissue sections of the liver, a number of rats in each group (after 20 days from the last injection) with hematoxylin-eosin staining, the tissue structure of the liver was examined by optical microscopy. Animals were weighed before and after treatment. In the first stage, only the mean of AST activity at 5 mg/kg/bw concentration was significantly increased (P<0.05). In the second stage, ALP activity was significantly reduced (P<0.05) in all doses higher than 2.5 mg/kg/bw and the activity of AST and ALT in doses of 5 and 10 mg/kg/bw was significantly reduced (P<0.05) and in the dose of 2.5 mg/kg/bw was significantly increased (P<0.05). Histologic studies revealed disturbances such as degeneration of the vein wall of the lobular center, degeneration of the nucleus and hepatocyte lysis with severe atrophy, irregularity and dilatation of the sinusoids and accumulation of inflammatory cells in the treatment groups in dose-dependent manner. Based on the above findings the most disturbances were related to the 20 mg/kg/bw concentration. It seems that multi-wall carbon nanotubes functionalized with carboxylic group, even in small amounts (2.5 and 5 mg/kg/bw) after 20 days, are toxic on the liver and cause liver tissue and function impairment.

  Attention deficit / hyperactivity disorder (ADHD) is one of the most common psychiatric disorders. This study was conducted to determine the effect of ear acupuncture on ADHD symptoms in children aged 7-14. This quasi-experimental study was performed on 30 children with ADHD whom did not receive Ritalin, whom referred to the private psychiatric clinic of children in Tehran. A questinare child syndrome inventory (parental form) and integrated visual and auditory (IVA) test with a pre-test and post-test design was used in this study. The ear acupuncture treatment for 8 weeks with uniform pressure on the ear seed was applied on five points of the ear, including brain, excitement, prefrontal cortex, shen men and tranquilizar. The auditory vigilance subscale from the attention area and the auditory prudence subscale of the auditory response from the inhibition area in the pre-test phase in compared to the post-test were statistically significant (P<0.05). The 8-week acupuncture on the ear improves the auditory vigilance subscale and the auditory prudence subscale in children with ADHD.

Divorce as a life crisis can lead to emotional and behavioral problems. This study was done to determine the effectiveness of group based reality therapy based on Glasser choice theory on the general health and obsessive beliefs of divorced women. In this quasi-experimental study 30 divorced women were non-randomly divided into the two interventions and control groups (15 participants in each group). Perior of the study the general health questionnaire (GHQ) (anxiety, social function, somatic symptoms and depression) and obsessive thoughts questionnaire (OBQ-44) (responsibility, perfectionisn and importance of thoughts) were completed by subjects in both groups. Counselling with Glasser approach was performed for intervention group through 8 group sessions once a week and lasted for 120 minutes. Control group received no intervention. At the end of the study, Post-test was performed from both groups. Group training based on reality therapy in intervention group's participants caused a significant reduction in all items of the two variables, general health and obsessive thoughts in compared to the control group (P<0.05). Group based reality therapy based on Glasser choice theory improves general health of divorced women and reduces their obsessive beliefs.

  Irrational beliefs underlie a wide range of cognitive impairments. This study was performed to compare the effect of cognitive-behavioral therapy and acceptance and commitment therapy on irrational beliefs of medical students. In this quasi-experimental study, 45 medical students of Golestan University of Medical Sciences in north of Iran were non-randomly divided into control, cognitive-behavioral therapy (first intervention) and acceptance, commitment therapy (second intervention) groups. All three groups completed the pre-test, but the control group did not receive any therapy. The intervention groups were received 8 sessions of therapy. The data were collected through Jones's 1969 (IBQ-40) irrational beliefs questionnaire. The total score of irrational beliefs in the both intervention groups were reduced in comparison with control group (P<0.05). The mean score of the problem-based avoidance subscale (35.26±6.32) was significantly reduced in the second intervention group compared to the first intervention group (30.53±9.47) (P<0.05). Also, the mean scores of emotional impulsivity in the first intervention group (22.73±9.49) were significantly increased compared to the second intervention group (29.93±1.75) (P<0.05). Two methods of cognitive-behavioral therapy and acceptance and commitment therapy reduce the irrational beliefs of medical students.

Recent conservative management of sub-acromial shoulder impingement (SSI) includes general strengthening exercises, especially for internal (IR) and external (ER) shoulder rotators. Despite various studies, so far, there is no directly investigated for indicating the difference in muscle strength between patients with SSI and normal subjects. This study was done to compare the shoulder joint muscles’ strength in male students with and without SSI. This case-control study was conducted on Twenty-four students with SSI as case group and 24 normal students as controls.The subjects in both groups matched for hand dominance and physical activity level, completed isokinetic shoulder IR and ER testing. In the case group, 18 patients had the symptoms in their dominant and 6 patients in their non-dominant side. Both sides IR and ER of shoulder were measured separately using continuous reciprocal concentric and eccentric contraction cycles at speed of 60 and 120 degrees per second, respectively. Values of peak torque were compared between the case and control groups. There was a significant difference between the two groups only when the symptomatic SSI shoulder was the dominant shoulder. Eccentric and concentric ER peak torque at 120 degree per second (22.20±7.01, 11.36±3.36), eccentric ER peak torque at 60 degree per second (20.53±6.15) and eccentric IR peak torque at 60 degree per second and 120 degree per second were significantly lower in the symptomatic dominant shoulder case group in compared to the dominant shoulder control group (P<0.05). Changes in eccentric and concentric peak torque in SSI group may be related to limb dominance, which may have implications for strengthening regimes. Therefore, clinicians and therapeutic exercise expertise may benefit from eccentric isokinetic exercises for shoulder IR and ER rotators in order to design a treatment plan for patients with SSI.

  Parents of children with autism have difficulty in their daily activities and social relationships and have a low quality of life. The negative effect of having a low intelligence or disabled child is more likely to cause tension and pressure on mother than the other family members. This study was conducted to determine the quality of life of mothers with autism children compared to mothers with normal children. This case-control study was performed on 36 mothers with autistic child and 114 mothers with healthy children in Gorgan (Iran) during 2015. Sampling was done randomly and the data gathering tool was SF-36 quality of life standard questionnaire. The quality of life of mothers with autistic child had a significant reduction in comparison with the quality of life of mothers with healthy child (P<0.05). Also, items of quality of life including general health, social function, and role limitation due to psychological, emotional and physical functioning in the group of mothers with autistic children were significantly lower than mothers with healthy ones (P<0.05). Mothers with autistic children had low quality of life. Therefore, it is recommended to design suitable programs for improving the health status and quality of life as a priority of health care plans

  The results of surgical treatment, successfulness and methods of evaluation in gender dysphoria are highly variable. This study was done to determine the status of sexual function in patients with impaired gender identity after sexual re-assignment male to female surgery. This cross-sectional study, conducted on 40 patients referred to surgery clinic in Tehran during 2014-2015. Female sexual function index (FSFI) questionnaire was used to assess the status of sexual function. Ninety- five percent of patients had a healthy sexual desire and arousal. Also, 75%, 55.4% and 27.5% of patients had satisfaction, moisture content and good orgasm, respectively. The pain was tolerable in 25% of cases; however, in terms of overall sexual function, only 12.5% of patients had a satisfactory sexual performance. The relationship between education, occupation, residence and previous history of mental illness with sexual function was not significant. Also, 42.9% of patients who had not desirable sexual performance, had a history of drug abuse, and all these subjects reported desirable sexual performance. Sexual function in cases that have undergone surgery was not suitable. Sexual pain and anorgasmia were important factors in this condition

  Environmental hazards are one of the most important threats to human health. The dramatic increase in population and new lifestyles has led to a variety of environmental problems and outbreaks of illness. This study was conducted to determine the attitude and knowledge in environmental behavior of citizens of Gorgan city, north of Iran. This descriptive-analytic study was carried out on 400 people (209 men and 191 women) in Gorgan citizens in northern Iran during 2017. A multi-stage sampling method was used to select the samples. The city of Gorgan was divided into 3 categories according to urban divisions, and the neighborhoods within the classes were considered as clusters. 40% of the neighborhoods were randomly assigned to each study. The instruments used for collecting data were demographic questionnaire and knowledge, attitude and environmental behavior questionnaires. The level of environmental attitudes and environmental knowledge of the citizens was poor and their Pro-environment behavior was highly valued. Persons with higher age, higher education and level of employment had better environmental behaviors (P<0.05). There was a significant and inverse relationship between environmental attitude and environmental behavior (P<0.05). Increasing
bio-environmental knowledge led to an increase in bio-environmental behavior (P<0.05). The level of knowledge and environmental attitude of Gorgan citizens was weak and their pro-environmental behaviors were strong.

  Health and social services have broad domain like encompassing healthcare, childcare and youth services, maternal services, senior citizen organizations, community centers and public amenities. Livability can be considered as the characteristics of the urban environment, which makes it an attractive place to live. This study was conducted to analysis of the urban livability of Mashhad in north-east of Iran metropolis based on health indicator. In this descriptive-analytical study the maps related to the status of each of objective sub-indicators including Spatial distribution of hospital, clinic, health center, emergency center and toilet based on the limits of Mashhad metropolis's zones (13 zones) were drawn by using the GIS Software. For mental indicator of health including physical health, relaxation, health services and satisfaction of health was used questionnaire. The sample size in all zones of Mashhad was equal 402 persons. 39% of Mashhad's zones are at health very unfavorable level with respect to the urban livability. The zone 13 of Mashhad metropolis was determined the best zone in terms of health indicator, followed by zones 8 and 11, respectively. In contrast, zones 4, 6 and 3 were determined the worst conditions in terms of health indicator, respectively. The livability of Mashhad metropolis is not in desirable status base on health indicator. The realization of Livable city in terms of health requires attention to both objective and subjective dimensions and Livability has dynamic, integrated and continuous process

Production of beta-lactamase enzymes is the most common mechanism of bacterial resistance against beta-lactam antibiotics. The aim of this study was to determine the antibiotic resistance pattern and the frequency of AmpC genes in Escherichia coli (E.coli) isolated in outpatients. In this descriptive-analytical study, 67 isolates of E.coli were investigated from urinary tract infection of outpatients of the largest medical center in Kermanshah, west of Iran. Their susceptibility to ceftriaxone, cefotaxime, ceftazidime, cefoxitin and imipenem antibiotics was determined using disk diffusion. AmpC phenotypic screening was performed using combination disk method (cefoxitin with and without boronic acid). After extraction the bacterial genome, the presence of MOX, CIT, DHA, ACC, EBC and FOX genes were tested by multiplex PCR. The resistance of 67 E.coli isolated to ceftriaxone, cefotaxime, ceftazidime and cefoxitin was 49.2%, 49.2%, 37.3% and 25.3%, respectively. The 100% of the isolates were sensitive to imipenem. Seventeen (25.3%) and 9 isolates (13.4%) were phenotypically and genotypically positive for AmpC, respectively. The prevalence of CIT, MOX, FOX, DHA and EBC genes was 7.4%, 5.9%, 4.4%, 4.4% and 2.9%, respectively. However, the ACC gene was not found in isolates. Except for significant correlation between AmpC phenotype and MOX gene (P<0.05), no significant statistical relationship was found between phenotype and AmpC genotype. There was a significant correlation between AmpC phenotype and ceftazidime antibiotic (P<0.05). There was a significant correlation between CIT gene and EBC and FOX (P<0.05). AmpC-producing E.coli isolates cause significant resistance to cephalosporins. One of the current therapeutic options is using of carbapenems. However, the relatively high prevalence and synergistic genes of AmpC in outpatients are a big concern and unfortunately it reflects the fact that these isolates are prevalent in the society.

  Duplex PCR is a widespread molecular biology technique that has the ability in specific and high sensitivity detection of microorganisms. This study was performed to evaluate the molecular identification of Pseudomonas stutzeri using duplex PCR. In this descriptive-laboratory study, Pseudomonas stutzeri ATCC 17588 bacteria was purchased from genetic resources center and after culturing the bacteria, DNA was extracted in the exponential growth phase using boiling method. Duplex PCR was carried out for specific identification of the bacteria subsequently. The primers were designed using catA and nirP gene sequences. Sensitivity and specificity of duplex PCR technique were investigated using 5 bacteria. The amplification of two bands of 512 bp and 249 bp for catA and nirP genes were observed, respectively. The specificity was 100% .The sensitivity of 0.048 ng/µL of genomic DNA was determined for catA and nirP genes, respectively. Duplex-PCR molecular method with its sensitivity and proper feature and high potential for identification of Pseudomonas bacteria can be applied as a routine method in well-equipped laboratories by expert technician to identify suspicious cases.