نشریه دانشگاه علوم پزشکی بیرجند
سال بیست و نهم شماره 1 (پیاپی 90، بهار 1401)

Dry skin is one of the most common skin complications associated with chronic renal failure in hemodialysis patients. Aloe vera gel and Violet oil can be effective in improving the symptoms of dryness through special mechanisms. Therefore, this study aimed to compare the topical effect of Aloe vera and Violet with hydroxyzine on dry skin of hemodialysis patients.

In this randomized crossover interventional trial, 36 people were selected according to the inclusion criteria and available sampling method. Following that, they were divided into three groups (12 cases per group) of A, B, and C by simple random sampling. The study consisted of three two-week intervention periods and two wash-out periods for one week. By performing a random allocation, all three groups received one of the interventions, including Aloe vera gel, Violet oil, or hydroxyzine tablets in each period. Data were collected using the VAS tool before and after the interventions by the co-researcher. The obtained data were then analyzed in SPSS software (version 16). Furthermore, SAS software (version 9.2) was also used to analyze crossover effects including period and carry-over effects. A P-value less than 0.05 was considered statistically significant.

The results showed that in the first and third periods, in all three treatments, the mean score of dryness intensity had a statistically significant decrease before and after the intervention (P<0.05); however, this reduction in the second period was not significant in none of the treatments (P>0.05). In addition, the effect of all three treatments showed no statistical significance on the severity of dryness in patients after the intervention (P>0.05).

All three treatments can improve the symptoms of skin dryness as equipotent in hemodialysis patients. However, further research is needed to confirm the results of this study.

Lung cancer is one of the most common malignancies worldwide that despite the recent progress, its existing treatments have not sufficient efficiency, and scientists are always trying to find complementary therapies. Medicinal plants, such as sour tea, have attracted lots of attention due to their abundant antioxidant compounds. In the present study, in addition to assessing the anticancer effects of sour tea (Hibiscus sabdariffa) on the human cellular model (A549) of lung cancer, the related molecular mechanism of anti-proliferative effects of the extract was investigated through the evaluation of the expression level of Bax and Bcl2 genes.

To this end, after the preparation of the sour tea extract, cellular cytotoxicity was evaluated with an MTT assay. Afterward, the cells were treated again with selective concentrations of the extract, and after 24 h, RNA extraction, cDNA synthesis, and gene expression analysis of apoptosis genes (Bax and Bcl2) were performed with a real-time polymerase chain reaction.

The results of the study showed that sour tea extract reduced the viability of cancer cells in a dose- and time-dependent manner. Furthermore, molecular analysis results revealed that the treatment of cancer cells with sour tea extract could increase the Bax/Bcl2 ratio, which is an important mechanism for triggering apoptosis.

According to the obtained results, sour tea extract had a cytotoxic effect on lung cancer cells, and therefore, could be suggested as a potential complementary therapy for lung cancer after experimental studies and clinical trials.

Intravenous immunoglobulin (IVIG) is one of the safest biological products, which is effective in the treatment of many diseases. This study aimed to evaluate the rational prescription pattern of IVIG based on the approved indications of the Food and Drug Administration (FDA) among teaching hospitals in Birjand, Iran.

This descriptive-analytical study included 300 patients receiving IVIG who were hospitalized in different wards of Razi and Vali-e-Asr hospitals in Birjand during 2016-19. Demographic characteristics, dose, duration of administration, duration of hospitalization, side effects, and other necessary information were extracted from patients' medical records. The collected data were compared with FDA-approved indications and dosages, followed by identifying the rate of rational prescription of the drug. The data were analyzed in SPSS software (version 19) through independent t-test (or Mann-Whitney) and Chi-square test to compare quantitative and qualitative variables in the groups, respectively.

According to the results, half of the patients were male (n=150; 150%). The mean age of the patients receiving IVIG was 28.17±27.01 years. Most of the patients receiving IVIG (30.3%) were hospitalized in the neurology ward. Guillain-Barre syndrome and immune thrombocytopenic purpura accounted for the most prescription of IVIG. In total, 133 patients (44.3%) (95%CI: 38.6-50.1) received the drug according to the FDA on-labeled indication. The dose of IVIG was rationally based on FDA in 33% of the cases (95%CI: 27.7-38.6).

Due to the limited availability and high price of this product, it is recommended to formulate and closely monitor the implementation of rational IVIG consumption in the hospital based on the regional standard protocol, especially with the presence of clinical pharmacists.

The critical importance of metabolic syndrome has necessitated the achievement of effective strategies to overcome the complications of this serious health condition. The present study aimed to evaluate the effect of eight weeks of intermittent running training on serum TNF-α levels and insulin resistance in male Wistar rats with metabolic syndrome.

This experimental study was conducted on 24 male Wistar rats aged six weeks and weighed 150-180 g.  They were purchased from Zahedan University of Medical Sciences and after being fed with a high-fat diet for 12 weeks and the induction of metabolic syndrome model, they were assigned to three equal groups (n=8): training+metabolic syndrome, metabolic syndrome, and healthy control. The intermittent training group performed running with an intensity of 80%-110% maximum intensity for two-eight repetitions on the treadmill. To measure biochemical parameters, blood samples were taken directly from the hearts. All statistical calculations were performed in SPSS software (version 20) using one-way ANOVA and Tukey post hoc test.

Serum TNF-α levels had no significant difference among groups (P=0.11); moreover, no significant differences were observed in insulin resistance among the groups (P=0.71).

Although there were no significant changes in TNF-α and Insulin resistance between groups, probably response to intermittent running training in metabolic syndrome model is affected by training intensity. More investigations are needed to get the mechanisms.

Cadmium chloride causes renal dysfunction. The present study aimed to investigate the protective effects of hydroalcoholic extract of Alcea rosea aerial parts on cadmium chloride-induced renal dysfunction in male rats.

In this experimental study, 54 adult male Wistar rats were assigned to six groups (n=9 in each group). The control group, the sham group1, received 0.2 ml of distilled water as solvent. Sham group 2 received 2 mg/kg cadmium chloride intraperitoneally (IP) for 21 days. Experimental groups 1, 2, and 3, respectively, received 2 mg/kg cadmium chloride IP for 21 days, followed by 150,300, and 450 mg/kg hydroalcoholic extracts of aerial parts of Alcea rosea intraperitoneally for 30 days. At the end of the experiment, blood samples were taken from all animals to measure levels of sodium, potassium, blood urea nitrogen (BUN), creatinine, and uric acid. The data were analyzed in SPSS software (version 18) using one-way ANOVA and Tukey post hoc test.

The mean serum concentrations of creatinine, BUN, sodium, potassium, and uric acid in all experimental groups showed a significant decrease, as compared to those in sham group 2 (P<0.05).

Based on the results, hydroalcoholic extract of aerial parts of Alcea rosea may improve cadmium chloride-induced renal dysfunction in male rats.

Intracellular reactive oxygen species (ROS) play an important role in cancer stem cell (CSC) function. Hesperetin (Hst) is a flavonoid that has been shown to affect cellular ROS level. The goal of this study was to investigate the effect of Hst on the level of ROS in gastric CSCs (GCSCs). MTT assay was used to evaluate cell survival. Cellular ROS level was measured using 2′,7′-dichlorofluorescin diacetate by flow cytometry. A significant decrease in the survival of GCSCs treated with Hst was observed. Hst decreased ROS level to about 47% and 40% at concentrations of 200 and 400 mM, respectively. It can be concluded that Hst reduces the survival and ROS level of GCSCs and may be influences the function of these cells such as proliferation and differentiation as well as response to chemotherapy by affecting cellular ROS level.

One of the most common complications of diabetes is diabetic foot ulcer, which exposes patients to wound infection, osteomyelitis, and lower-limb amputation if left untreated. Therefore, accurate and rapid diagnosis of wound and osteomyelitis infection is an important step in treating this debilitating complication. In this regard, the present study was aimed to determine the incidence of osteomyelitis and assess its risk factors in patients with diabetic foot ulcers during 2013 and 2016 in Birjand, Iran. This epidemiological analytical-retrospective study was conducted using numerical sampling. Demographic and clinical data were obtained by reviewing patients’ medical records and using a checklist developed by the project manager. Data analysis was performed using SPSS software (version 18). Quantitative and qualitative results were reported as mean±standard error and percentage, respectively. The obtained findings indicated a significant association between the location of foot ulcers and the risk of osteomyelitis (P=0.02); accordingly, osteomyelitis is more likely to occur in diabetic ulcers on the toes. However, no significant difference was observed between right and left foot ulcers in terms of osteomyelitis risk. Mean erythrocyte sedimentation rate was also significantly higher in diabetic patients with osteomyelitis than those of non-osteomyelitis ones (P=0.04). However, no significant difference was observed in C-reactive protein and leukocytosis. The age and gender of the patients had no significant effect on the risk of osteomyelitis. Overall, the results of the present study demonstrated a significant relationship between the location of foot ulcers and the probability of osteomyelitis. Accordingly, ulcers located on the toes are more likely to develop osteomyelitis.

The prognosis of patients with cardiac arrest depends on the provision of high quality cardiac massage and the nurses are expected to be able to provide high-quality cardiac massage. Therefore, this study aimed to investigate the quality of cardiac massage and its effective factors in 90 nurses of Birjand hospitals, Birjand, Iran, in 2019. This cross-sectional descriptive study was conducted using the available sampling method. Moreover, four quality items of cardiac massage (depth, speed, full chest recoil, continuity) were examined using a Q-CPR device and extracting the percentage of optimal performance of each item. According to the obtained results, the Mean±SD of the total scores of cardiac massage quality, massage depth, continuity, speed, and full chest recoil were recorded at 30±15, 20±27, 21±20, 26±38 and, 22±35 by Q-CPR device. A significant increase was observed in the quality of massage in males compared to females, after passing a resuscitation workshop, and with the increase of education level (P=0.03). There was a significant difference between and the quality of cardiac massage measured by the Q-CPR devise after the cardiac resuscitation workshops and the quality of cardiac massage before the workshop (P=0.01). There was a significant association between the level of education and the quality of cardiac massage measured by the Q-CPR device (P=0.001). The results indicated that only 30% of cardiac massage performed by nurses was performed correctly, which was not desirable. Therefore, it is necessary to look for methods that lead to the higher efficiency of nurses in performing high-quality cardiac massage. It seems that there is a need for the use of audio and video feedback tools during the cardiac massage as well as resuscitation workshops with a skill-enhancing approach. Further studies are recommended to provide effective feedback to nurses and paramedics in order to observe the standards of high-quality cardiopulmonary resuscitation.

Tetanus is a neurological disease associated with increased muscle contraction and spasm in patients. The risk and progression of the disease are higher in elderly patients. Numerous elderly people in our country, especially in rural areas, lack tetanus vaccination in childhood. Due to the weakness of the immune system in the elderly, this study aimed to assess the tetanus immunity in the elderly over 60 years old in Birjand, Iran, 2018-2019. In this cross-sectional descriptive study, the level of tetanus antibody was measured in serum samples of 186 individuals from the elderly population of Birjand in 2018-2019. The mean level of tetanus antibody was estimated at 0.355±0.63 IU/ml, showing that 132 (71%) cases lacked immunity against tetanus (95% CI: 0.23-0.36). In the present study, the level of tetanus antibody decreased significantly with aging (P=0.002), and a significant difference was observed between the job and the level of tetanus antibody (P=0.003). The mean level of tetanus antibody increased significantly in individuals with an increase in education level (P=0.018). However, the mean level of tetanus antibody showed no significant difference with the living place (P=0.232) and gender (P=0.872). In this study, more than 70% of the elderly lacked immunity against tetanus, indicating the need for more attention in providing more health services to the elderly.

In evidence-based medicine, constructing research questions is the most important part of research integration. Formulating a research question is the first step to conducting a credible and valuable research. Patient, intervention, comparison, outcome (PICO) is a specialized framework used by most researchers to formulate a research question and facilitate resource review. In the heart ward of Razi Hospital, Birjand University of Medical Sciences, according to the needs assessments, PICO was implemented during the Journal Club to familiarize students with research and increase their level of knowledge, attitude, as well as clinical reasoning skills. In this article, we explain the case of a 36-year-old woman with typical chest pain for 3 hours due to severe stress, without cardiac risk factors referring to the emergency room. The clinical examination was normal. The ST elevation was observed in the aVR lead. The question is “Should we perform an invasive intervention for this patient?