نشریه پژوهش در پزشکی
سال چهل و پنجم شماره 4 (پیاپی 180، زمستان 1400)

The Coronavirus Disease-2019 (COVID-19) epidemic caused by SARS-CoV-2 is spreading worldwide and it poses major health threats to public health. It seems that understanding pathogen genome details during disease outbreaks provide crucial information leading to identification of novel treatment goals

Urolithiasis, with different types of stones, is known as a considerable concern regarding urinary tract. Indeed, urolithiasis is a multifactorial disease with a wide range of risk factors which predisposes patients to it. Because of the importance of urolithiasis around the world and the considerable costs for patients and public health and treatment centers associated with urolithiasis, we made an attempt to determine the most important risk factors in association with urolithiasis.

To prepare  the present systematic review, the English language papers with no limitation in publication date were searched in search engines like Google Scholar and databases, including PubMed, and websites, like ScienceDirect. In this regard, papers which covered the main aim of the study were selected for final analysis.

The prevalence, type, and composition of urinary system stones have different reasons and risk factors. The urinary tract stones are divided into microbial and non-microbial stones. Although urolithiasis is a multifactorial disease, nutrition, as the dominant risk factor, plays pivotal role in prevention, diagnosis, and treatment of urolithiasis.

Men >60, <40, and 40-60 years old are more predisposed to urinary tract stones (both the microbial and non-microbial stones) compared with other age ranges. In contrast, the occurrence of microbial stones in women is higher than that of men because the rates of urinary tract infections are higher in female population. All in all, age, gender, catheterization, urinary tract disorders, geographic zone, climate, season, race, diet, physical activities, drug-induced stones, water and liquid application, gastrointestinal and urinary tracts’ normal flora, inheritance, occupation, and diseases such as gout and diabetes type II are identified as the most important factors of urolithiasis.

Prevalence of obesity has remarkably been elevated during the recent years and therefore its consequences, including liver and cardiovascular disorders, have increased. The previous studies have shown that trans-palmitoleic acid (tPA) has beneficial effects in metabolic disorders. Thus, the aim of the present study was to study the effects of tPA on lipid accumulation in liver cells and the gene expression of fatty acid synthase (FAS) enzyme and the activity of peroxisome proliferator-activated receptor alpha (PPARα).

In the present experimental in vitro study, HepG2 liver cells were cultured and treated with different concentrations of tPA and palimitic acid. Intracellular triglyceride (TG) levels were measured with an enzymatic method, and the expression of FAS gene was assessed using real-time PCR. The activity of PPARα was also evaluated via luciferase reporter assay, using the vector comprising the PPARα response element.

Both fatty acids caused TG deposition in liver cells; however, the TG levels were significantly lower in cells treated with tPA compared to the cells that were treated with palmitic acid (P<0.001). The gene expression of FAS was enhanced by both fatty acids, but in cells treated with tPA, it was significantly lower than palmitic acid (P<0.001). Also, tPA was obserced to activate PPARα, especially at lower concentrations (P<0.001), while palmitic acid did not have any effect on this nuclear receptor.

The results showed that less TG is accumulated in liver cells treated with tPA as compared with palmitic acid and thus this fatty acid has better influence on liver cells compared with its saturated counterpart.

Bleeding is one of the most common problems in patients undergoing septorhinoplasty, which can affect the course and condition of patients during and after surgery. Therefore, the present study was conducted to investigate and compare the effects of Tranexamic acid and intravenous Desmopressin on reducing the amount of bleeding during Septorhinoplasty.

In the current randomized double-blind clinical trial, 105 patients undergoing Septorhinoplasty in Firoozgar Hospital and Hazrat Fatemeh Hospital in Tehran in 2019 were selected as available sampling and randomly divided into three groups: Tranexamic acid group, intravenous desmopressin, and placebo. The blood loss and satisfaction of the surgical team and hemodynamic changes were determined and compared in the three groups.

The level of satisfaction in the desmopressin group was more than those of the two groups of tranexamic acid and placebo (P = 0.0001). Also, blood loss in the desmopressin group was lower than those of the other two groups (P = 0.0001). Hemodynamic changes in the three groups were not observed to be statistically significant.

Tranexamic acid and intravenous desmopressin were more effective in reducing bleeding during septorhinoplasty, especially in the case of desmopressin.

Considering the impact of total body water on the amount of saliva production, it seems that an increase in water intake can be used as a potential treatment in patients with saliva production disorders. The present study aimed to investigate the effect of increased water consumption on the level of saliva production.

In the current study, 60 patients (50 aged 20-25 and 10 aged 50-55 years) were selected. This selection helped authors to evaluate changes in the passages of years. Participants were asked for drinking a substantial amount of fluids in a limited time (2 hours). Sterile gasses were used for measuring saliva production. Gasses were weighed before and after placement in the mouth to obtain saliva production weight and volume. After a basement measure of saliva production, participants were asked to drink a total of 1.6 liters of water gradually every 15 minutes using a glass with 200 cc capacity. After 90 seconds, the saliva amount was evaluated again in the same way once without stimulation and then with saliva production stimulation using vinegar and chewing. The same process was repeated after 2 hours. The amounts of saliva in the two groups before and after drinking water were measured in stimulated and unstimulated situations. Paired t-test was run to compare saliva and ANOVA was used to compare age groups. Statistical analyses were performed using SPSS, version 22.

Based on the results of the current study, there was a significant difference between the amount of saliva production before and after drinking water in both stimulated and unstimulated situations (P=0/01). It was revealed that the younger group showed greater changes in saliva production after drinking water in comparison to the older group.

Based on the findings, it can be concluded that increasing fluid intake can improve the symptoms of dry mouth via saliva production improvement and potentially prevent the recurrence of salivary gland stones.

Reduction of any mobility and activity can cause many diseases as cardiovascular diseases. The aim of the present study was investigation of the effect of a combined training period (aerobic and High Intensity Interval Training) and high intensity interval training on Homocysteine and ESR in cardiovascular patients.

In the current experimental study, 32 cardiovascular patients were selected voluntarily and were randomly divided into 3 groups: combined training group (n = 10), HIIT training group (n=11), and control group (n = 11). Inclusion criteria included injection fraction greater than 30, lack of tachycardia and bradycardia, and lack of functional capacity less than 5 met, and the exclusion criteria included unwillingness to continue the activity and diagnosis by a physician. The protocol of the HIIT training group included performing 2-3 times a week of HIIT training during the first 4 weeks and performing 3 times a week of HIIT training during the second 4 weeks.Blood samples were taken 24 hours before the first training session and 48 hours after the last training session, under the same conditions for all the three groups. Data analysis was performed using paired sample t-test, ANOVA, and post hoc with a significance level set at P˂0.05.

The performing of combined exercises and HIIT was found to have a significant effect on reducing serum homocysteine levels (combined exercise (baseline values of 19.7± 1.3, after intervention 13.8 ± 2.3, P˂0/00), HIIT exercise (baseline values: 20.0± 1.3, after intervention: 16.3± 1.5, P˂0/001)) and ESR levels (combined exercise (baseline values: 27.7 ± 2.1, after intervention: 22.13 ± 1.27, P˂0/005), HIIT exercise (baseline values: 26.2 ± 2.8, after intervention: 22.9 ±2.0, P˂0/004)) compared with the control group (Homocysteine P˂0/619, ESR P˂0/306) of cardiovascular patients.

Combined and HIIT trainings seem to be effective in reducing homocysteine and ESR in cardiovascular patients, while the effect of combined exercise is greater than that of HIIT.

The use of alternative approaches to supplement alveolar nerve anesthesia other than the conventional nerve block has received little attention by dental professionals, although they are associated with less complications compared with contemporary injections. This may partly be due to the small amount of research in this regard. The present study assessed the effectiveness of two techniques of conventional and Gow-Gates nerve blocks for inferior alveolar nerve anesthesia in patients referring to the Department of Oral and Maxillofacial Surgery at Shahid Beheshti University of Medical Sciences, Tehran. 

A randomized clinical trial was carried out on 120 patients requiring IAN anesthesia for mandibular posterior teeth extraction (60 cases for each technique). The injections were perfromed using two inferior alveolar nerve block techniques: the conventional and Gow-Gates block, selected by random order using standard protocol. The time required for the onset of anesthesia in different nerves was recorded according to the patient responses and the injection complications were noted. The data was subjected to Chi-square and Mann-Whitney U tests. 

The mean time required for anesthesia onset in all nerve blocks (inferior alveolar, mental, incisive, lingual, and long buccal) were significantly different between the two conventional and Gow-Gates techniques (p<0.001). Positive aspirations were shown in 1.7% of patients receiving Gow-Gates and 20% of patients in conventional techniques. Furthermore, 16.7% of patients required supplemental injections in the conventional method while there was no need for such injections in the Gow-Gates group. Also, 23.3% of teeth receiving Gow-Gates block and 13.3% in conventional technique required repeated injections. 

Although all the studied nerves received delayed anesthesia in Gow-Gates injections, the use of this technique is effective in maintaining successful inferior alveolar nerve anesthesia due to the reduced injection complications and less frequency of needed supplemental injections.

Decreased levels of testosterone and dehydroepiandrosterone sulfate (DHEA-S) have been reported as anabolic risk factors for  health in young people. The aim of the present study was to investigate the effect of resistance training and resistance training with neurofeedback on serum levels of testosterone and DHEA-S in young males. 

A total of 30 young males were divided into resistance training (n=10), resistance training and neurofeedback (n=10), and control (n=10) groups. The training groups performed resistance training and neurofeedback training for eight weeks. In both pre- and posttests, the levels of testosterone and DHEA-S were measured. Combined analysis of variance was used to compare the means between groups and paired t-test was used to compare the means within the group.

Compared to control group, serum testosterone levels increased significantly following resistance training and resistance training with neurofeedback in young males (p=0.01). Also, dehydroepiandrosterone sulfate levels, compared to resistance training group, had a significantly higher increase in the resistance training with neurofeedback group (p=0.01). Also, serum cortisol levels were significantly reduced (p = 0.001) in the resistance training with neurofeedback group, but its reduction in the resistance training group was not found to be significant (p = 0.31), as
compared with the control group. .

Anabolic and catabolic hormones appear to respond better to electrical stimulation of the brain with resistance training.

In patients with myocardial infarction, preventing the deposition of lipoproteins in the vascular wall is an important factor in rapid recovery and functional capacity returns doing exercise. Therefore, the aim of the present study was to investigate the effect of increasing endurance training on the risk of cardiovascular risk factors in infant specimens.

A total of 20 Wistar rats aged 8-10 weeks with a mean weight of 230±30g were divided into two groups of infarction control (MI.Co) and infarction (MI.Ex). After inducing experimental myocardial infarction with two intraperitoneal isoproterenol injections at a dose of 150 mg/kg for 24 hours, the exercise group performed an endurance training protocol on the treadmill for eight weeks. Applying the same conditions followed at least 24 hours after the last training session. To examine the significant changes in the levels of Cholesterol, TG, LDL, and HDL, independent t-tests were run in Graph Pad program.

Serum LDL and TG levels in the infarct training group decreased significantly (2.12 and 13.87 mg/dl, respectively) compared with the infarct control group (p=0.03). However, cholesterol and HDL levels increased in the infarct training group, as compared with the infarct control group (5.25 and 4.12 mg/dl, respectively), which was observed to be significant only in HDL levels (p=0.03).

It seems that the use of non-pharmacological strategies, such as increased endurance training, can significantly reduce LDL and TG levels and, in turn, significantly increase HDL levels in patients with myocardial infarction.

Due to the prevalence of Recurrent Aphthous Stomatitis (RAS) and its complications and the importance of its etiology as well as contradictory reports of the relationship between serum 25-Hydroxyvitamin D levels and RAS, the present study aimed to determine the relationship between serum 25-Hydroxyvitamin D levels and RAS in individuals referred to the Department of Oral and Maxillofacial Medicine at the School of Dentistry of the Islamic Azad University of Tehran in 2018.

Methods and Materials:

 The study was conducted using a case control method. The samples included 30 patients: 15 patients with RAS and 15 controls. The two groups were matched in terms of age, sex, and inclusion criteria. Exclusion criteria included suffering from systemic diseases, blood diseases, Behcet's disease, autoimmune diseases, iron deficiency, folate deficiency, and vitamin B12 deficiency as well as multi vitamin, iron, calcium, and vitamin D consumption during the past 3 months.Each volunteer received 5 ml of blood and their serum 25-Hydroxyvitamin D level was determined using HPLC device. The quantitative values, ​​in terms of ng/ml, and their qualitative values, ​​based on normal values, ​​were analyzed statistically running t-test and Fisher's exact test.

Serum 25-Hydroxyvitamin D level in the control group was 85.5 ± 33.59 ng / ml and was 87.33 ±12.65 ng / ml in the case group. In terms of quality, 66.7% in the control group and 40% in the case group had abnormal serum 25-Hydroxyvitamin D levels.

It seems that 25-Hydroxyvitamin D does not seem to play a role in RAS. For more accurate results, furthure studies with larger sample sizes are recommended

Due to the prevalence of sublingual varices, especially in the elderly, and the importance of etiologic studies and the reported, varicose veins are probably related to sublingual varices. The present study was conducted on elderly patients with sublingual varices and their control group in Kahrizak Alborz in 2018.

A case control study was conducted by referring to Kahrizak Charity Sanitorium. First, a list of the elderlies over 60 was made. The purpose of the study was explained to those in the list and they were included as the sample of the study following their consent. The experimental group included those with sublingual varices and those without sublingual varices were included in control group. Both groups were homogenized in terms of age, gender, smoking, and high blood pressure. Diagnosis of sublingual varices and varicose veins were done based on clinical examination and standard methods of diagnosis. The sublingual varices of the participants were diagnosed based on interviews and examination in a private room. The roles of varicose veins were evaluated running Chi-square test.

A total of 109 patients with sublingual varices and 109 control participants were studied. The subjects in the two groups were similar or did not have significant differences. Exposure to varicose veins in case group was 67 (61%) and 49 (45%) in the control group (P<0.025).

It seems that patients with sublingual varicose tend to be more exposed to varicose veins.

One of the thriving pharmaceutical sectors is the antibiotic market, which is widely used to cure infections. However, the irrational use of antibiotics can cause microbial resistance. Due to the increasing consumption of antibiotics in Iran and the world, this pharmaceutical class's market research provides excellent insight for healthcare providers and is therefore of great importance. The present study is a practical and time-series study using 16 years of antibiotic sales data.

The digital sales of antibiotics from 2002 to 2017 were obtained from the Iranian Ministry of Health. Then, the sales patterns of each antibiotic category were examined.

In 1396, 9.54% of the pharmaceutical market in Iran belonged to antibiotics. The highest sales were for Penicillins (38.87%) and Cephalosporins (25.92%), and the lowest sales for Carbapenems and Glycopeptides (0.33%) categories. In general, Cephalosporin, Carbapenem, Lincosamides, Glycopeptides, Macrolides, and Quinolones had growing sales patterns during the 16 years studied, while Aminoglycosides, Sulfonamides, and anti-tubular medicines had declining sales patterns. 

The use of antibiotics is showing an increasing trend in Iran. Also, there is a concern about increase in the use of broad-spectrum antibiotics, such as Cefixime, Cefepime, Azithromycin, and Meropenem. Therefore, there is a need to establish regulatory policies for antibiotic prescription and consumption and proper management in this area.

Anxiety is a common problem that can negatively affect outcomes of an operation. The main propose of the present study was to investigate the effects of anxiety on hemodynamic parameters in pregnant women, candidate for elective cesarean section under spinal anesthesia.

Totally, 300 pregnant candidates for elective cesarean section participated in our study. To assess the severity of anxiety, patients were asked to complete DASS questionnaires before surgery and the hemodynamic parameters were recorded before spinal anesthesia, skin incision, uterus incision, and delivery time, at the end of the surgery and in the recovery room.For normal distributed data, t –test was used and to determine whether there is a significant difference between the means of the two groups. Also, repeated measures Analysis of Variance (rANOVA) was run to see how level of blood pressure changes in the different levels of anxiety score.

In the present cross-sectional study, the prevalence percentages of mild, moderate, and extremely severe anxiety in the participants was 8.7 (n= 26), 38.79 (n=115), and 52.5 (n=157), respectively. There was a statistically significant correlation between severity of anxiety and the average of systolic, mean arterial blood pressure, and heart rate.Systolic blood pressure values in the moderate, severe, and extremely severe anxiety levels were found to be 131.3±5.9, 132.2±5.7, and 136±7.4, respectively (P≤0.001) Also, the mean arterial blood pressure values in the moderate, severe, and extremely severe anxiety levels were 99.4±5.8, 99.2±5.9, and 101.6±6.8 (P≤0.01). Futhermore, heart rate increased in these three levels from 82.1±6.3 to 85.5±8.7 and then 91.3±8.9 (P≤0.001).Patients with higher anxiety scores showed higher levels of systolic, mean arterial blood pressure, and heart rate. But it did not seem to have clinical importance.

According to our findings, anxiety results in higher levels of hemodynamic parameters. Also, in parallel with the increase in the severity of anxiety, more hemodynamic changes may be observed in surgery, which had statistical difference although not clinically important.

Backgrond:

 During the past two decades, Acinetobacter baumannii has been introduced as an important clinical pathogen due to its remarkable ability to cause infections and to acquire resistance to the currently used antibiotics, including β-lactams, aminoglycosides, and tetracyclines. The aim of the present study was to determine the pattern of antimicrobial susceptibility and the prevalence of armA, tet(39) genes, and the insertion sequence ISAba4 in A.baumannii strains collected from burn patients referred to Shahid Motahari hospital in Tehran. 

Totally, 92 clinical isolates of A.baumannii were collected from the burn wounds of inpatients in Motahari hospital in Tehran. The isolates of Acinetobacter were identified using laboratory and microbiological tests. Then, for the identification of species, the molecular method was carrid out by detecting the presence of the blaOXA-51 gene. The pattern of antibiotics susceptibility was performed via disk diffusion and the minimum inhibitory concentration (MIC) was performed via microdilution broth, according to CLSI guidelines. The prevalence of armA, tet(39) genes and the insertion sequence ISAba4 were investigated using PCR and Sequencing.

Out of 92 A.baumannii, 95.6%, 89.2%, 97.9%, and 81.5% of the isolates were resistant to gentamicin, amikacin, imipenem, and tetracycline, respectively. All the isolates were also resistant to meropenem. The armA gene was detected in 58% of the isolates, while all strains carried tet(39) and the insertion sequence ISAba4 was detected in only 3.2% of the isolates.

Our study showed a relatively high distribution of armA, tet(39) genes, and the insertion sequence ISAba4 in clinical isolates of A.baumannii. This can lead to increased concerns and irreparable health costs. Drug administration, recognition of the pattern of antibiotic resistance in A.baumannii, and the study of the molecular epidemiology can be effective in counteracting antibiotic resistance.

Urinary tract infection is one of the most common bacterial infections in the world and Europathogenic Escherichia coli is one of the main causes of this infection. The presence of fimbrial genes causes the bacteria to attach to the cells of the urinary tract. The aim of the present study was to evaluate the presence of 3 fimbrial genes papEF, sfaD, and fimH in Escherichia coli isolated from patients with urinary tract infections.

In the current cross-sectional study, 235 urine samples were randomly collected from patients referred to different laboratories in Amol between 2018-2019. First, each sample was cultured separately on EMB agar and then analyzed using biochemical tests, such as IMViC, TSI, and urease. In positive samples for the presence of Escherichia coli, antibiogram test was performed to evaluate the sensitivity to the imipenem. After DNA extraction from imipenem resistant samples via boiling method, the presence of papEF, sfaD, and fimH genes was examined using Polymerase Chain Reaction (PCR). The results of the study were analyzed in SPSS, version 22. Statistical analyses were performed running Man-Whitney and Chi-square tests with a significance level of P<0.05.

From among the 235 urine samples, 75 (31/9%) contained Escherichia coli bacteria. Also, 47 samples (62/7%) were detected from imipenem-resistant Escherichia coli isolates. After PCR reaction, it was found that 28 isolates (59/6%) were positive for fimH gene, 8 isolates (17%) were positive for papEF gene, and 19 isolates (40/42%) were positive for sfaD gene. The results showed that, among the studied strains, fimH gene was the most common gene encoding fimbriae in Escherichia coli isolated from urinary tract infection in Amol city. However, this finding was not statistically significant (P <0.05). Also, in the statistical study of the results of antibiotic resistance and the presence of fimbrial virulence genes, no significant relationship was observed between the variables (P <0.05).

It seems that fimH gene is the most common gene encoding fimbrial in Escherichia coli isolated from urinary tract infections in Amol city and is an important factor in the pathogenicity of this bacteria. Most cases of urinary tract infections are associated with Escherichia coli bacteria that contain these genes, so its early detection in patients with urinary tract infections can help treat patients in a faster and better way.

Distant metastasis is a notorious feature of melanoma. Although rare, the parotid gland may be prone to melanoma metastasis owing to its lymphatic drainage. Incidence of melanoma increases with age; in fact, it is extremely rare for melanoma to occur in individuals younger than 20 years. It is important to be aware of the causes of parotid mass, which can a be source of metastatic melanoma from the skin of head and neck.

In the present case report, we report on a 19-year-old female with a history of a previously resected melanocytic nevus of the scalp with slowly-growing bilateral synchronous parotid masses, found to be metastatic melanomas of both parotid glands. The patient underwent superficial and deep right parotidectomy followed by left total parotidectomy along with lymph node dissection of the cervical chain at both sides. No evidence of tumor recurrence was detected during the 18-month follow-up.

Metastatic melanoma should not be dismissed as a differential diagnosis in patients presenting with bilateral synchronous, slowly-growing masses of parotid glands in young adults.