نشریه پژوهش در پزشکی
سال چهل و چهارم شماره 1 (پیاپی 173، بهار 1399)

Exposure to cadmium may negatively affect the male reproductive system via degenerative changes in the testes, epididymis, and seminal vesicle. Cadmium induces testicular lipid peroxidation by generating free radicals, thereby impairing the intracellular defense system. In folk medicine, the linden (Tilia platyphyllos L.) is used as a diuretic, stomachic, antispasmodic, and sedative agent. Previous studies have identified several phytochemicals, such as terpenoids, phenolic acids, and flavonoids, in flowers and leaves. The aim of the present study was to investigate the effects of linden extract on cadmium-induced testicular damage in male Wistar rats. 

In the current experimental study, rats were randomly divided into 10 groups: normal control, linden extract (50, 100, 200, and 400 mg/kg intragastrically, daily) alone, infertile control rats (cadmium chloride 3 mg/kg intragastrically, daily), linden extract (50, 100, 200, and 400 mg/kg intragastrically, daily) together with cadmium chloride, and the treatment was performed accordingly. At the end of experiment (28 days), testes were removed for histopathology investigations. The tissue was postfixed in bouin buffer solution and dehydration, clarification, paraffin embedding, molding methods were performed. Histopathological changes (seminiferous tubules, number of spermatocyte, and spermatozoa, spermatid) were examined via Eosin and Haematoxylin staining. The testes pathology was scored using Johnsen score. Data were analyzed using one-way analysis of variance.

Our results showed that the mean of Johnsen’s score significantly decreased in the infertile control group compared to those in the normal control groups (p<0.001). The administration of linden extract prevented this histological alteration and significantly increased the mean Johnsen’s score in infertile rats. The histopathological studies on the tissues obtained from the the testes showed that linden extract significantly reduced (p<0.001) the toxicity of cadmium and preserved the normal histoarchitecture pattern of the testes.

Our results suggest that linden acts as a potent antioxidative agent against cadmium-induced testicular toxicity in rats.

Nowadays, cancer is one of the most important medical problems. Breast cancer is also considered as the most common cancer of women: its prevalence has risen throughout the world in recent centuries and people can experience recurrent events that sometimes accompany with a terminal event. In the present study, using a frailty model we tried to model recurrent event in the precence of terminal event (death) in breast cancer patients.

In the current retrospective survival study, 342 patients with breast cancer registered in the cancer research center of Shohada-e-Tajrish Hospital were examined. The Liu model was used to joint modeling of recurrent events and terminal events, in which a shared frailty with Gamma distribution was used. Estimation of the parameters was done by the penelized maximum likelihood method and the frailtypack package in the R software version 3.4.1 was used to implement the model and analyzed the data. Significance level was set at 0.05.

In our cohort study, 342 women with breast cancer were studied. A univariate and multivariate analyses was performed for these patients. Of these, 78 cases (25.4%) had recurrence events, and 225 patients (74.6%) were censored. The obtained results of joint frailty model indicated that the relative risk of relapse in patients with first-degree familial history was 36% higher than that of other people (P <0.05). Relative risk of relapse in patients with stage 3 disease was 19% more than other stages and also the relative risk of relapse in patients with chemotherapy were 2.5 times higher than those without chemotherapy.

It seems that by investigating the effects of factors affecting the occurrence of recurring events with death with regard to unknown factors, such as modeling, we can simultaneously simulate the probabilistic nature of the disease and provide more accurate information to the researchers.

Patients undergoing mechanical ventilation require continuous sedation to reduce anxiety; however, the type of sedative is controversial. In spite of the widespread use of propofol in such patients, propofol administration is associated with different complications such as increased vascular resistance, depression, and blood pressure drop; the evidence is extensively observed in the literature. The current study aimed at comparing the characteristics of patients receiving and not receiving propofol during the treatment.

In the current historical cohort study, 500 patients admitted to the Intensive Care Unit (ICU) of Masih Daneshvari Hospital were selected using purposive sampling method. Accordingly, 250 patients were assigned to the propofol group and 250 others to the non-propofol group. The study groups were analyzed based on Richmond agitation-sedation scale (RASS), the critical-care pain observation tool (CPOT), hypotension, and length of hospital/ICU stay using Chi-square, the Fisher exact, and t-test.

Comparison of the two groups showed that the CPOT score was significantly lower in the non-propofol group (1.5±0.7) compared with the propofol group (2.9±1) (p = 0.036). Also, the level of blood pressure drop in the propofol group was significantly higher than that of the non-propofol group (p = 0.023). Comparison of the two groups in terms of the quality of sedation based on RASS score indicated the superiority of the non-propofol group to the propofol group; therefore, the comparison of mean scores (-1.2±0.2 vs -0.7±0.2) showed a significant difference between the two groups (p=0.036).

Based on the results of the current study, it seems that receiving propofol increases the probability of hypotension and the length of hospital/ICU stay, and based on the studied variables, propofol has a lower sedative quality and pain control capability in patients.

Obtaining informed consent is necessary for non-emergent interventions. Interventions that promote informed consent are effective for both patients and the medical staff. The current study was conducted to study the effects of improving informed consent and obtaining presumption of innocence on compliants against doctors after elective lumbar disk surgery in Tajrish hospital.

Methods and Materials:

In the present experimental study,  a total of 1000 patients, admitted for elective lumbar disk surgery in Tajrish hospital, were selected using simple random sampling and according to the including criteria. Then, the participants were divided in two groups: the control group received a consent form with brief information including the diagnosis, the proposed treatment, alternative treatments, and their risks and benefits, and the risks and benefits of declining treatment. The intervention group received a more detailed information form, including more details about the risks of treatment, unwilling harm to the patients through system failures, and predictable human error. The patient’s consent and innocence forms were obtained from the latter, too. Next, the the two groups were followed for over two years after surgery and the complaints against doctors were compared by analyzing the data in SPSS, version 21, running Exactly Fisher test. 

There was no significant difference between the patients' sex and age and the number of complaints (p<0.012) nor was any significant difference between the site of surgery and complaints (p<0.1). Yet, complinats agianst doctors in the first group was %8 compared with the 1% complaints in the second groups, which shows a statistically significant difference. 

Obtaining a more complete informed consent form as well as presumption of innocence results in lower complaints against the physicians.

Kidney failure is one of the most important health problems. The average life expectancy of dialysis patients is 3 to 5 years and . tThehe most common cause of death is cardiovascular events. Common risk factors for heart disease such as diabetes and hypertension alone do not justify the high risk of such events in these patients. The role of inflammation and the increase of inflammatory factors have been discussed more than other causes. Interleukin-6 has the strongest prognostic power to predict death in dialysis patients and is the best component of the expression of underlying inflammation. The purpose of this the present study was to determine the association of interleukin-6 with echocardiographic findings in dialysis patients.

In this the current descriptive study, 52 adult patients (19 to 80 years old) with ESRD undergoing dialysis were selected from available samples. Data was provided with a checklist containing the variables studied including age, gender, duration of onset and as well as underlying cause of kidney failure and history of heart disease. Interleukin 6 was determined by using ELISA technique. Echocardiographic findings, including Ejection Fraction, inter ventricular septum diameter, and left ventricular end diastolic diameters, were all determined by one cardiologist with using a fixed echocardiography device. Data were analyzed using SPSS, software  version 23.

Dialysis patients with severe heart failure had higher levels of IL-6 than other dialysis patients (P-value= 0.044). There was no significant relationship between serum interleukin 6 with inter ventricular septum diameter and left ventricular diastolic diameter.

It seems that, IL-6, as an important factor, indicates severe heart failure and high mortality in dialysis patients. There is no relationship between the level of interleukin 6 and the ventricular septum and left ventricular diastolic diameter.

Hyperbilirubinemia is a common and often benign problem in neonates.
Severe neonatal indirect hyperbilirubinemia associated with neurological developmental disabilities, including auditory, cognitive and motor disorders. Motor disorders include dystonia, athetosis that is consistent with lesions of core nuclei. The tone and coordination abnomality are signs of lesion in cerebellum. Hyperbilirubinemia and kertnicterus-induced hearing loss include hearing processing imparment and sensorineural hearing loss. The goal of this study was to determine the neurological developmental  outcome and kernicterus in children at ages 24-36 months who had severe neonatal hyperbilirubinemia.

In a longitudinal study, newborns  that admitted to hospital with severe neonatal indirect  hyperbilirubinemia were followed. In one year, 181 neonates were admited and treated for severe jaundice. At the age 24 to 36 months, 121 cases were followed and evaluated for kernicterus.

In this study 121 patients were followed that 52 patients (43%) were girls and 69 (57%)  were boys. The age of newborns at admission was 4.14±1.27 days and their birth weight was 3102 ±559 grams. The mean values of billirubin was 21.29±4.21 mg/dl at the time of hospitalization. Twenty eight patients (19.83%) had underwent exchange transfusion in addition to intensive phototherapy, of which 8 neonates(6.61%) had evidence of ABO incompatibiliry. These 8 patients had received intravenous immunglobolin to prevent the need for second exchange transfusion. Among the followed patients,  3 infants (2.47%) had developmental delay and diagnosed as kernicterus, of which 2 neonates had exchange transfusion due to ABO incompatibility.

In this study, less than 3% of infants with severe neonatal hyperbilirubinemia developed  kernicterus. It is necessary to inform parents about neonatal jaundice and its complications. Severe jaundice should be taken serious in the first days of life because of risk for kernicterus. Severe neonatal hyperbilirubinemia, if not treated properly and quickly, can cause developmental delay.

Pseudomonas aeruginosa is an opportunistic pathogen and management and treatment of infections caused by drug resistant strains of P. aeruginosa has become a major challenge(1). The aim of the present study was to investigate the prevalence of resistant isolates of P. aeruginosa class I integron in clinical and environmental samples.

In current descriptive study on 101 samples, patients with cystic fibrosis admitted to the pediatric ward and patients with burn infections were included. Samples from ulcers and throat were collected and analyzed by microbiological and biochemical methods. Antibiotic susceptibility testing was performed by disk diffusion method according to CLSI guidelines. DNA was extracted and gene for class I Integrons was amplified.

Of 101 strains isolated from patients (37 from cystic fibrosis and 64 from burn patients) which drug susceptibility was performed, 97.02% was susceptible to colistin and 30.6% was susceptible to amikacin and Pipracilin. Most resistant drug shown for ceftizoxime 97.2% and Ceftriaxone 67.3%.  From the isolated strains, 18 isolate show complete resistant, 7 intermediate resistant and 76 were pan-susceptible. According to our analysis, 50% of isolate have MDR resistance. Based on PCR analysis, of 101 isolates, 60 (%59.4) have integron class 1 gene. This gene was significantly associated with strains resistant to amikacin, tobromycin, ciprofloxacin and pipracillin.

there was an increasing concern about the resistance of P. aeruginosa to the most available antibiotics such as colistin, amikacin and imipenem.

Free living amoebae include many genera such as Acanthamoeba, Naegleria, Balamuthia and sapinia. These opportunistic FLA could be the causal agent of various diseases including Keratitis, Encephalitis and Cutaneous ulcers. These amoebae could be present in water sources. the aim of the present study is to isolate FLA from Hot springs samples collected from various districts in hot springs of Mahallat located in the Central Province by employing morphological and molecular method. The presnet study was conducted for the first time in summer 2016.

In this study, 87 samples were collected from 5 hot springs , 24 pools and small pools. Three samples with 500 ml volume were taken in sterile bottles and transferred to laboratory of Shahid Beheshti University of Medical Sciences. Based on culture and morphological and molecular criteria, hot springs contamination to free living amoebae was examined.

Out of 77 collected samples, 33 (42.85%) samples were contaminated to free living amoebae. The most prevalent amoebae were Vermamoebae vermiformis 18 (54.54%), Acanthamoeba isolates belonging to T4 12 (36.36%) and Naegleria australiensis  3 (9.09%).

The results indicated the presence of potentially pathogenic Vermamoebae vermiformis, Acanthamoeba isolates belonging to T4 and Naegleria australiensis  in Hot springs of Mahallat located in the Central Province. Improved filtration and posting alarm signs are necessary to exclude such amoebae from Hot springs. It seems hot springs contamination to free living amoebae is relevant and this could be a health hazard for endemic people, tourists and travelers who use these hot springs. Improved disinfection and filteration of hot spring is important for prevention of diseases that are caused Such as Keratitis, Encephalitis and Cutaneous ulcers.

Nausea and vomiting during cesarean section are common under spinal anesthesia. The aim of the present study was to investigate the prevalence of nausea and vomiting and the related factors during elective cesarean under spinal anesthesia.

A descriptive study was performed on 200 pregnant women who were candidates for elective cesarean section under spinal anesthesia in Taleghani Hospital between 2017-2018. For each participant, age, number of pregnancies, number of deliveries, history of previous cesarean section, nausea and vomiting in previous cesarean section(s), smoking during pregnancy, nausea and vomiting during the first trimester of pregnancy, premenstrual syndrome, and motion sickness were asked and  BMI, duration of operation, the highest level of blocked dermatome, baseline pulse rate, and systolic pressure decreased by more than 20%, the incidence of nausea and severity, or vomiting during surgery, and the sex of the infant were recorded. Data were fed into SPSS column, version 21, and analyzed using descriptive statistics and independent t, Mann-Whitney, Chi-square, and Fisher exact tests. P-values less than 0.05 were considered significant. 

The prevalence of nausea and vomiting were 58% and 16%, respectively. The history of nausea and vomiting in the first trimester of pregnancy, pregnancy with the female fetus, and systolic pressure decreased by more than 20% in both groups of patients with nausea (P< 0.001) and vomiting (P<0.001) during cesarean section under spinal anesthesia were more prevalent than those without nausea and vomiting. Also, the prevalence of motion sickness (P <0.047) and history of nausea and vomiting during the previous cesarean section were significantly different in the non-nauseous group after spinal anesthesia (P <0.004) in patients with nausea during surgery. The highest level of blocked dermatome was significantly different in both groups with and without vomiting (p <0.001).

The currrent study showed once more that nausea and vomiting were common during cesarean section under spinal anesthesia. It seems that checking some factors in the medical history of a person may help in predicting this complication.

Rheumatoid arthritis is a chronic inflammatory disease that is associated with the risk of atherosclerotic disease. Cardiovascular disease is the main cause of mortality in RA patients. In recent studies, the prevalence of metabolic syndrome and its components in RA patients has been shown. By measuring the risk factors for the risk of developing a metabolic syndrome, the degree of mortality and cardiovascular and morbidity in patients with RA can be counted.
This cross-sectional study was performed on 200 RA patients based on the ACR classification, from patients who referred to the rheumatology clinic of Imam Khomeini Hospital from March 1992 to March 93. The main outcome was the prevalence of metabolic syndrome based on the two criteria of the International Federation of Diabetes and the Iranian definition. The secondary outcomes of the study were the prevalence of various components of the metabolic syndrome, as well as various demographic, anthropometric, laboratory, and RA drugs used in the metabolic syndrome.
 Metabolic syndrome was significantly associated with smoking. Among RA, prednisolone (glucocorticoids) and azathioprine, there was a significant increase in the chance of having a metabolic syndrome, and there was a significant association between the metabolic syndrome and the inflammatory factors of CRP or ESR, anti CCP and RF were not found. But DRA was lower in subjects with metabolic syndrome than in others.
Metabolic syndrome is a high prevalence in RA patients. Considering the risk factors responsible for increasing the chance of developing a metabolic syndrome in this potentially high risk population is necessary.

Maximum oxygen uptake is considered the best indicator of cardiorespiratory fitness, direct measurement, however, is complicate, expensive, time consuming, and requires high subject cooperation. The numerous test have been developed to estimate Vo2max. Heart rate is a one of variables that determine VO2. So using Fick principle develops an equation for a relationship between Vo2max and the ratio between HRmax and HRrest. This study examined the validity of the equation.

This is a case control study, 19 healthy, nonsmoking women divided into 2 groups. The evaluation test was performed by the RITE3 protocol. Estimated Vo2max based on age was calculated using the equation and HRmax placement was proportional to age instead of HRmax measured.

The results of the study showed that the equilibrium of the measured equation was 17.7±3.03 ml.kg-1.min-1. Also, the results showed that between Vo2max measured and estimated Vo2max (p = 0.177) and between corrected Vo2max and the estimated Vo2max based on age (p = 0/67) is not significantly different. In addition, the results showed that between age and Vo2max and corrected Vo2max, between BMI and Vo2max, between HRrest and Vo2max and corrected Vo2max is not significantly different. But there is a significant correlation between BMI and corrected Vo2max.

According to the results of this study, it can be admitted that Vo2max cannot be estimated by calculating the formula.

Bisphenol A (BPA) is a chemical substance that is used in large amounts to produce polycarbonate plastics and epoxy resins. Exposure to low levels of BPA can lead to a variety of health outcomes. Stem cells are undifferentiated cells with the ability to divide and differentiate into different cell types. It is important to investigate the effects of BPA on stem cells.
 

A comprehensive study was conducted on BPA and its effects on stem cells by searching the keywords including Stem cells, Bisphenol A, Obesity in the medical valid databases, mainly PubMed. Among the collected papers, articles that are the most relevant to the purposes of writing this article were selected and studied.

It seems that BPA increases autophagy induction in stem cells and also stimulates stem cell differentiation into adipocytes.