مجله دانشگاه علوم پزشکی مازندران
پیاپی 214 (آبان 1401)

Wound is a complication that is highly prevalent. The aim of this study was to investigate the effect of a lipogel formulation containing Rhamnus cathartica L., a native Iranian plant, on wound healing in Wistar rats.

In this experimental study, to find the best lipogel formula, several formulations with different ratios of paraffin, polyethylene and extract were examined. Twenty rats were divided into four groups (n=5), including normal saline, lipogel base, extract lipogel, and active water. Full-thickness wound of 2*2 cm was induced in the ​​ dorsal area. Wound size evaluation and histopathological study were done at days 3, 5, 7, and 12.

The formulation containing 95% paraffin and 5% polyethylene was selected due to better skin coverage, good consistency, and better uniformity. Total phenolic content and total flavonoid content of R. cathartica were 4.5 mg/g and 23.415mg/g, respectively. In vivo results indicated significant differences in wound size between the treatment group and other groups (P≤0.05). Histopathology studies showed that the R. cathartica extract had a better effect on collagen deposition, necrosis, fibroblast maturation, and epidermis formation compared with other groups (P≤0.05).

This study showed that lipogel containing the R. cathartica extract was effective in full-thickness wound healing.

Crocin as a carotenoid exert anti-inflammatory, anti-oxidant, and anti-diabetic effects. There is an increasing prevalence of diabetes mellitus and its complications and patients are more interested in natural product treatments. This study aimed at investigating the efficacy of crocin and losartan alone and combination of the two drugs on insulin resistance and protecting pancreatic tissue in an animal model of diabetes.

In this experimental study, diabetes was induced by a single intraperitoneal injection of streptozotocin (50 mg/kg) in 40 rats .Four weeks after induction of diabetes, the treatment groups received crocin (50 mg/kg) and losartan (25 mg/kg) daily or combination of these drugs for 4 weeks via gavage. Then, FBS, weight, insulin, and lipid profiles were investigated and histopathology of pancreatic tissues were evaluated.

Findings showed that crocin and losartan can be effective in improving the symptoms of diabetes (hyperglycemia, increase in body weight, increased HOMA-IR, QUICKI reduction, hyperlipidemia, and pancreatic tissue damage). Also, combination of crocin and losartan increased its effectiveness in improving the symptoms of diabetes.

According to this study, crocin could contribute to development of phytotherapeutic techniques in treatment of diabetes and its complications. Also, this study showed that crocin in combination with losartan increases the effectiveness of losartan against diabetes. However, more human studies are needed to confirm these benefits.

The antioxidant Nrf2/Keap1 pathway prevents cellular damages against oxidative stress and this pathway is disrupted following diabetes. The aim of this study was to investigate the effect of endurance and resistance training on antioxidant Nrf2/Keap1 pathway in testicular tissue of diabetic rats.

In this experimental research, 48 male Wistar rats were randomly divided into six groups: control, resistance training control, endurance training control, diabetic, diabetic resistance training, and diabetic endurance training. Diabetes was induced by intraperitoneal injection of 120 mg/kg nicotinamide and 65 mg/kg streptozotocin after 12 hours of fasting. Seventy two hours after induction of diabetes, resistance and endurance training protocols were performed for 10 weeks. Afterwards, the expression of Keap1, Nrf2, and HO1 genes in testicular tissues were measured by real-time PCR.

According to findings, induction of diabetes significantly decreased the expression of Nrf2 and HO1 (P<0.05), while the expression of Keap1 increased (P>0.05). Endurance training significantly increased the expression level of Nrf2 (P<0.05) and resistance training changed the expression level of genes related to Nrf2/Keap1 pathway (P>0.05).

Endurance and resistance exercises could activate Nrf2/Keap1 signaling pathway on gene expression following diabetes and by activating this pathway the complications of diabetes on testis might be reduced.

Pain is an unpleasant sensory and both pharmacological and non-pharmacological methods are applied in sedation management. The analgesic effect of metoclopramide has been reported in some studies. The aim of this study was to evaluate the analgesic effect of intrathecal administration of metoclopramide in rats.

In this interventional-experimental study, 30 male rats were divided into five groups (n=6 per group). Groups 1, 2, and 3 received 2.5 mg/kg, 5 mg/kg, and 10 mg/kg spinal metoclopramide, respectively. Group 4 received 1 mg/kg lidocaine and group 5 (control) received only distilled water. Pain threshold was measured by tail flick test and pain intensity was measured by formalin test. Quantitative pain intensity was measured every five minutes for one hour. Data analysis was carried out in SPSS V26 applying One-way Analysis of Variance and Kruskal-Wallis test.

The study showed that pain threshold was highest in group 4 that received lidocaine (P= 0.003). There was no significant difference in the onset of pain between the control group and group 1 (P= 0.079). Pain intensity was found to be lower in group 4 than other groups and group 3 (10 mg/kg metoclopramide) compared with groups 1 and 2 )P=0.019).

Metoclopramide is effective in reducing the severity of postoperative pain and higher doses are associated with better results.

Oxidative stress and neuroinflammation are the main causes of cerebral ischemia. Saponin with steroid or triterpenoid compounds with a sugar part has strong antioxidant and anti-inflammatory properties. The aim of this study was to evaluate the effect of saponin on cerebral edema, Bax gene expression level, and ischemic neurological defects.

In this experimental study, 24 male Wistar rats were divided into three groups: sham, stroke, and stroke+saponin. Rats in the stroke+saponin group received intravenous injection of saponin (3mg/kg) 30 minutes before cerebral ischemia. Each group was divided into two subgroups: brain edema (n=5) and gene expression level investigation (n=3). Cerebral ischemia was induced by middle cerebral artery occlusion model. After 24 hrs, we investigated neurological deficits resulting from ischemia (Kruskal-Wallis test), the degree of brain edema, and Bax gene expression levels in the cortex, piriform cortex-amygdala, striatum, and hippocampus (one-way ANOVA).

Findings indicated a significant decrease in the score of neurological defects resulting from ischemia, the amount of cerebral edema, and the level of Bax gene expression in stroke+saponin group (P<0.05).

This study showed that saponin pretreatment in rats with ischemia-reperfusion injury can be effective in reducing the damage caused by cerebral ischemia.

Myelin degradation is one of the main causes of some neurological diseases. There is growing evidence that plant essential oils may reduce the risk of demyelination. In this experimental study, using a lipidomics approach, we investigated whether administration of Nigella sativa (NS) essential oil could improve changes in the profile of spinal fatty acids in demyelination model induced by intra-spinal administration of ethidium bromide (EB) in mice.

In this experimental study, 30 male rats were studied in five groups (n=6). The groups included control without treatment, solvent, and black seed essential oil (2, 5, and 10 ml/kg, intraperitoneally). The essential oil of NS was prepared and its fatty acid composition was determined by gas chromatography-mass spectrometry (GC-MS). The animals underwent intra-spinal administration of ET 0.2%. At the end of the experiments, samples were taken from the spinal cord of the rats and the concentration of seven different types of fatty acids in the homogenate of the spinal cord was measured and compared between the groups.

Ethidium bromide disturbed the normal concentration of polyunsaturated fatty acids, increased arachidonic acid derivatives, and decreased docosahexaenoic acid in rat spinal cord. Treatment with NS essential oil significantly prevented these changes in a dose-dependent manner (P<0.01).

NS essential oil protects against EB-induced demyelination by regulating the level of endogenous fatty acids in spinal tissue.

Cancer is one of the causes of mortality worldwide. Evidence suggests that iron depletion by a chelator agent suppresses the development of some cancer cells. Deferasirox is shown to have anticancer properties. This research aims to synthesize and evaluate the effects of deferasirox nanoparticles on human breast cancer cells (SKBR3) and mouse breast cancer cells (4T1) compared with the drug form.

Deferasirox nanoparticles were synthesized by Poly lactic-co-glycolic acid (PLGA) moiety with emulsion formation and solvent evaporation. Cytotoxicity was evaluated using the MTT assay and their 50% inhibitory concentration (IC50) were assessed in SKBR3 and 4T1.

Findings showed that IC50 of nano-deferasirox for SKBR3 and 4T1 were 9.09±0.011 µg/ml and 6.6±0.032 µg/ml, respectively and the IC50 of the deferasirox drug form for SKBR3 and 4T1 IC50 were 21.07±0.003 µg/ml and 11.08±0.013 µg/ml, respectively.

The anticancer effects of deferasirox were confirmed on the cell lines, and the improved properties and efficacy were also confirmed on two cancer cell lines. Nanoparticle delivery systems improve absorption and drug properties and increase the effectiveness of the drug.

In the present study, Micro-capsulated fish oil omega-3 fatty acids and Lactobacillus Plantarum produced by electrostatic interaction coacervation was investigated in three biopolymer formulations.

Three biopolymer formulations of fish gelatin-gum Arabic, fish gelatin–chitosan, and gum Arabic-gelatin were used to study the effect of wall materials. Also, we investigated the effect of wall-to-core materials ratio at 2: 1, 3: 1, and 4: 1 and homogenizer speeds of 3500 and 7000 rpm.

The results of the microencapsulation efficiency of omega-3 fatty acids showed that treatment 12 had the highest yield (96.26 ± 0.19). It contained a biopolymer mixture containing gelatin-chitosan which surrounded a high percentage of omega-3, while the amount of omega-3 on the surface of the capsule was very low. Also, treatment 6 containing gelatin wall materials and gum Arabic had a high ability to surround bacteria and compared to free bacteria, the bacterial mortality rate was lower when exposed to simulated gastric conditions. In addition, after being in the simulated intestinal condition, the number of bacteria increased after 120 minutes that shows the capsule has released its compounds in alkaline conditions of the intestine.

This study showed that using the combined coacervation technique using fish gelatin biopolymers, chitosan, and gum Arabic as wall materials, can produce omega-3 capsules and Lactobacillus Plantarum in micrometer sizes. They can play a protective role in preventing the oxidation of probiotic and omega-3 bacteria.

Tuberculosis is one of the major global health problems with high mortality. Establishing a rapid and low-cost identification method is significant, especially in developing countries. In this study, we aimed to design an indirect ELISA system with low molecular weight antigens secreted by Mycobacterium tuberculosis strain C, for identification of Mycobacterium tuberculosis Complex infection in human.

The secretory proteins from culture filtrate of Mtb strain C extracted by Sephadex-G50 were used as target antigen in designing an indirect ELISA system. Then, human sera with tuberculin skin test, culture, acid-fast bacilli smear, and PCR test results were selected to detect human serum antibodies against these low molecular weight proteins.

During gel chromatography and SDS-PAGE (12.5%) analysis, the purified protein F2 fractions with approximately 0.7 mg/ml and molecular weights in the range of 14-40 kDa were used as the target antigen in designing the indirect ELISA system. The ELISA system designed by F2 showed 78% sensitivity and 92% specificity in identifying tuberculosis.

The ELISA results based on low molecular weight proteins, with the sensitivity and specificity achieved in this study, might support the hypothesis that the Mtb culture filtrate antigens could be used as a rapid and sensitive assay in ELISA test for detection of pulmonary TB.

Urinary incontinence is a common problem in general population, especially old women and decreases their quality of life. The purpose of this study was to evaluate the effect of topical black seed oil on urinary incontinence in old women.

The present double-blind randomized clinical trial was conducted in 80 women aged 60-80 years old with stress, urge and mixed urinary incontinence in Sari, Iran. They were randomly assigned into two groups: an intervention group (black seed oil, n=40) and a placebo group (Firooz baby oil, n=40) using block randomization. Both groups applied 15 drops of the group-specific oil twice a day (morning and night) for six weeks from the area below the navel to the pubic area. The rate of urinary incontinence was measured in both groups using the International Consultation of Incontinence Questionnaire – Short Form (ICIQ-SF) before the intervention and at the end of weeks three and six. Data were analyzed by descriptive and inferential tests.

Independent t-test showed no significant difference between the intervention and placebo groups in the ICIQ-SF score in pre-intervention phase (P>0.05). At week three, a significant decrease was seen in the score for urinary incontinence in the group that received black seed oil compared with that of the placebo group (4.59 vs. 5.89, P=0.004). Also, at week six, the mean ICIQ-SF score in the intervention group was significantly lower than that in the placebo group (2.21 vs. 5.32, P<0.001).

The current study showed that the topical use of black seed oil for three weeks was effective in improving urinary incontinence symptoms in old women which also increased after six weeks.

Appropriate drug regimen during colonoscopy is one of the matters of concern in anesthesia. This study was conducted to compare the efficacy of propofol-ketamine combination and propofol-fentanyl in colonoscopy.

In a single-blind randomized clinical trial, 200 patients aged 18-60 years candidate for colonoscopy, were randomly allocated into two groups to receive either fentanyl-propofol (PF) or ketamine-propofol (PK) using block randomization. Recovery time (end of injection until Steward Score was 6) as the primary outcome and vital signs, complications, total dose of propofol, and satisfaction of the doctor performing the colonoscopy as secondary consequence were compared between the two groups.

Recovery time was 2.97 ± 0.89 min in the fentanyl-propofol group and 8.84 ± 1.73 min in ketamine-propofol group (P<0.001). Systolic and diastolic blood pressure and heart rate significantly decreased in the fentanyl-propofol group compared with the other group (P <0.001) which was persistent until five minutes after colonoscopy. Restlessness was seen in 28 patients receiving propofol-ketamine but no patient in fentanyl-propofol group developed this condition (P <0.001). Satisfaction of the doctor performing the colonoscopy and propofol dose were significantly better in patients that received ketamine-propofol (P<0.05).

Fentanyl-propofol combination was associated with faster recovery time and less restlessness than the ketamine-propofol compound, but the latter combination is recommended as it led to better hemodynamic stability, greater satisfaction of the doctor, and reduced dose of propofol.

There are many studies on the health effects of dietary advice and physical activity in pregnancy while only a few reported the effects of simultaneous administration of motivational interviewing, dietary advice, and physical activity on neonatal outcome in pregnant women with metabolic syndrome (MetS). This study was designed to examine the effects of these interventions on fetal-neonatal outcome in pregnant women with MetS.

A randomized, single‑blind, controlled clinical trial was performed in 120 pregnant women with metabolic syndrome at 15- 20 weeks of gestation in two hospitals in Babol, north of Iran, 2018. The participants were allocated into two groups (n= 60 per group) using blocking randomization and were followed up until the end of pregnancy. Fetal-neonatal outcomes were compared between the two groups from week 32 of pregnancy. The interventional program included one motivational interview, two nutrition consultation sessions, and three sessions of physical activity (per week).  The control group received routine care. Demographic and fertility characteristics, anthropometric measurements, and biochemical and pregnancy outcomes were recorded. Data analysis was done applying independent t test, ANOVA, and logistic regression.

The incidence of respiratory distress syndrome was found to be significantly lower in intervention group (3.7%) compared with the control group (14.5%) at the end of the pregnancy (P=0.01).

Dietary recommendations, motivational interviewing, and physical activity in pregnant women with MetS during prenatal care can be used as safe and practical interventions to prevent respiratory distress syndrome.

Carpal tunnel syndrome (CTS) is one of the most common neuropathies caused by entrapment of the median nerve in the wrist. The purpose of this study was to evaluate the electrodiagnostic changes before and after carpal tunnel release (CTR).

The present descriptive study was conducted in 24 patients (38 hands) with CTS in order to evaluate the electrodiagnostic changes before and 12 months after CTR and to investigate the relationship between electrodiagnostic changes and Boston score, DASH score, and Grip and Pinch strength. Data were analyzed using SPSS V20.

Electrodiagnostic study showed that the mean distal motor latency (DML) significantly decreased from 6.7 ±2.12 ms to 4.70 ±0.61 ms (P=0.0001) and the mean distal sensory latency (DSL) significantly improved (from 4.98 ±1.06 ms to 4.54 ±0.75 ms, P=0.012). Findings showed no significant differences in mean DML and DSL between right and left hands (P=0.378, P=0.233). There was a significant positive correlation between age and DML and DSL after CTR (r=0.475, P=0.001, and r=0.341, P=0.024, respectively). No significant correlation was observed between postoperative electrodiagnostic findings and Boston score, DASH score, and Grip score ({sss: P=0.931, fss: P=0.629}, P=0.169, P=0.1000, respectively).

Postoperative electrodiagnostic findings significantly improved, but there was no clear association between EMG NCV and the severity of postoperative clinical symptoms. Therefore, in order to evaluate the outcome of CTR, combination of clinical symptoms with electrodiagnostic findings is considered valuable.

Controlling the severity and death of the COVID-19 disease is still a major challenge. This research aimed at identifying the factors associated with mortality in hospitalized patients with COVID-19 applying generalized linear model.

In this cross-sectional study, demographic and clinical data of COVID-19 patients hospitalized with positive RT-PCR test results (n=6759) in Mazandaran hospitals (August 2019) were obtained from the national registration system for COVID-19. SPSS V27 and R V4.0 were used for data analyses and multivariate generalized linear model test with an ordinal logistic scale was applied.

Findings showed that full recovery and relative recovery occurred in 5888 (87.11%) and 400 (5.92%) patients, respectively. Mortality rate was 6.97%. The chance of death in patients with relative recovery (49.55%) compared with those with full recovery (21.61%) was almost 2.3 times higher. Predictors of mortality in these patients included age over 60 years (OR: 1.60), ICU admission (OR: 5.09), intubation (OR: 4.10), SpO2≤ 93% (OR: 2.41), cancer (OR: 1.74), diabetes (OR: 1.29), heart disease (OR: 1.41), and chronic kidney disease (OR: 2.17).

Specific and timely medical care, considering the mentioned risk factors, should be introduced and provided to prevent mortality in patients hospitalized with COVID-19.

P24 is one of the important components of retroviruses capsid. Several studies have shown the inhibitory effect of melittin protein on the function of AIDS virus. The aim of this study was to evaluate the effect of this protein on P24 in SIV and HIV viruses using bioinformatics software.

P24 protein sequences of SIV and HIV were obtained from a gene bank and their features were analyzed using different software programs. Also, structural similarities of P24 protein between SIV and HIV viruses were examined. Docking analysis was used to examine the interactions between melittin and P24 proteins. The stability of docking results were confirmed by molecular dynamics simulation.

Findings showed numerous phosphorylation, glycosylation sites, and di-sulfide bonds in P24 protein. Docking results indicated a probable interaction between P24 protein of both viruses and melittin. The results showed similarity of the third structure of P24 protein between the two viruses. Analysis of molecular dynamics showed molecular stability of the interactions between P24 and melittin proteins.

High energy values of the interaction between melittin and P24 indicated high binding potential of the two proteins, which can determine the inhibitory effect of melittin on the function of HIV capsid. Analysis of the third structure of P24 protein in both viruses showed that they are very similar despite the high difference in protein sequences from the point of view of folding and 3D structure. Application of melittin to control SIV infections in primates can be used as a model for inhibiting HIV in humans.

Valid and reliable tools are needed to assess the health literacy of heart failure. This study was performed to validate the Persian version of Heart Failure-Specific Health Literacy Scale (HF-Specific HL Scale).

In this methodological study, 360 patients with heart failure completed the Persian version of HF-Specific HL Scale in two medical centers affiliated with Mazandaran University of Medical Sciences. Factor structure was evaluated using structural validity, convergent and divergent validity. The scale reliability was evaluated by internal consistency (Cronbach’s alpha) and construct reliability.

The results of exploratory factor analysis showed that the scale has two factors: difficulties in understanding prescriptions and hospital pamphlets and understanding the disease and trying to improve knowledge about it, which account for 42.20% of the variance. Cronbach's alpha of the scale was higher than 0.7 and factor loading of the items was more than 0.5 indicating significant correlation coefficient of the items. The fit indices of the model showed that the extracted factor structure was suitable.

Factor structure of the HF-Specific HL Scale in patients with heart failure showed a two-factor structure. In addition, considering the acceptable validation results of the scale, the Persian version can be used as a reliable tool for measuring health literacy in patients with heart failure.

Ventilator-associated pneumonia (VAP) is a relatively common disorder that is associated with higher mortality than other nosocomial pneumonias. Various antibiotics, including meropenem are used in treatment of this disease. The present study was designed to evaluate the population pharmacodynamics of meropenem.

This cross-sectional study was carried out in 57 patients with VAP. All patients received iv infusion of meropenem (1 g) every eight hours and the pharmacokinetic parameters obtained from these patients were used in a parallel study to simulate the duration of plasma concentration above the minimum inhibitory concentration (MIC). Standard microbiological tests were used on tracheal aspiration samples to identify the microbial etiology of VAP, and MIC against bacterial infection was determined by E-test. Finally, the time when the drug concentration was higher than the MIC between two consecutive administrations was calculated.

The prevalence of VAP pathogens was similar to the results of other studies. In 90% of patients, the MIC of meropenem against VAP-producing microbes was more than 32 µg/ml (ratio of free drug concentration above MIC) indicating resistance to treatment and only in four patients was less than 0.064 µg/ml, which indicates sensitivity to treatment.

Due to the high prevalence of meropenem resistance among VAP-producing pathogens, meropenem administration is recommended after antibiogram evaluation.

Hyperdontia is defined as supernumerary teeth (ST) in deciduous or permanent dentitions which can cause a variety of dental, occlusion, and cosmetic problems. This study aimed to evaluate the prevalence and location of ST in different classes of malocclusion in a population of orthodontic patients attending a private orthodontic clinic in Sari, North of Iran between 2006 and 2021.

In this cross-sectional study, the records of 4873 patients were reviewed. ST characteristics and malocclusion classes were studied using panoramic radiography, lateral cephalometry, and intraoral photographs. Data analysis was performed in SPSS ver.26 applying Chi-square, Mann-Whitney, Kruskal-Wallis, and Fisher's exact test.

Out of 4873 records, 36 (0.74%) patients had ST. These included 21 (58.3%) women and 15 (41.7%) men with a mean age of 23.39±10.76 years. The prevalence of ST was not significantly associated with sex, classes of malocclusion, and the type of teeth (P= 0.317, 0.02, and 0.18, respectively). However, significant correlations were found between the incidence of ST and the direction (unilateral or bilateral), malocclusion, and type (maxilla or mandible) and direction (left or right) of the jaw (P<0.001).

Distribution of ST is significantly associated with the direction, malocclusion, and left or right jaw. Nevertheless, additional studies are required in order to offer the best treatment.

Muscle damage has always been a serious problem following accidents and spinal cord injuries. Mental imagery or motor imagery is a treatment in which a patient evokes a movement to improve performance. There are limited studies in this field, so, this study aimed at investigating the effect of mental imagery on increasing the strength of elbow flexor muscles.

This study was performed in 20 healthy individuals, non-athletes aged 22-25 years old. The strength of the elbow flexor muscles was measured by a dynamometer and a special tape measure was used to measure the hypertrophy of the biceps muscle. The experimental group performed strength training designed for the superior hand using free weights and at the same time performed this exercise mentally with the non-superior hand (three days a week/12 weeks). Mann-Whitney U test was used to compare the changes between superior and non-superior hand and Wilcoxan test was used to compare the amount of changes in maximum muscle contractile force.

Findings showed increased elbow flexor strength and hypertrophy in both the superior hand and non-superior hand.

Although real exercises were more effective in improving strength and hypertrophy of flexor elbow muscles, but mental imagery also affected muscle strength and hypertrophy as much as real exercises.

Desmoid tumors (DTs) are slow-growing tumors with no malignant or metastatic features but are locally invasive. These tumors have an unpredictable but varied clinical course. Intra-abdominal sporadic DTs are very rare and have a worse prognosis due to the mass effect on abdominal organs. This paper reports the diagnostic and surgical treatment of a 34-year-old man with DT of the small intestine without any genetic predisposing factor or history of trauma and abdominal surgery. The patient initially had mild pain in the periumbilical area and then presented with exacerbation of abdominal pain, acute abdominal symptoms, and peritonitis during elective diagnostic procedures. Abdominal CT scan with contrast injection showed a hypodense area with irregular borders and open-air foci of 171*160*85 mm in the middle of the abdomen and displacement of intestinal loops. Diagnostic and therapeutic laparotomy revealed a very large mass (18 cm in diameter) in the mesentery of a large part of the small intestine, a purulent abscess adjacent to the mass, and perforation of the D4 part of the duodenum. Debulking resection of the tumor was performed due to the involvement of the upper mesenteric artery. Preoperative elective core needle biopsy, surgical biopsy, and immunohistochemistry reports revealed desmoid tumor. Desmoid tumor as a benign tumor can have aggressive manifestations similar to intra-abdominal malignancies.