مجله علمی دانشگاه علوم پزشکی کردستان
سال بیست و هفتم شماره 5 (پیاپی 122، آذر و دی 1401)

Diabetes is a metabolic disease with high blood sugar levels. Olfactory ensheathing cells (OECs) are able to express various growth factors and integrin-linked kinase (ILK) plays an important role in regulating various processes of cells. In this study, we investigated the effects of silybinin on the expression of vascular-endothelial growth factor (VEGF) and ILK under normal and high glucose conditions in OECs.

In this study, OECs were extracted from the olfactory mucosa of neonatal rats and cultured. Low (1,5M) and high (50,75 µM) concentrations of silybinin were added to the cell culture media under normal and high glucose conditions. At the end of the study, we measured the expression of VEGF and ILK proteins using western blot technique. Data were analyzed by ANOVA test.

Under high glucose conditions, low concentrations of silybinin maintained expression and at high concentrations silybinin caused a dose-dependent decrease in ILK significantly. However, under high glucose conditions, low concentrations of silybinin significantly decreased expression of VEGF but high concentrations of silybinin caused a significant dose- dependent increase in VEGF expression.

High glucose condition increased ILK and VEGF expression in the OECs, and treatment with lower concentrations of silybinin maintained ILK expression and decreased VEGF expression. Therefore, it seems that lower concentrations of silybinin can be effective in protecting cells from cytotoxicity due to diabetes hyperglycemia by stabilizing ILK and reducing VEGF levels.

Background and Aim:

 It has been reported that lithium (Li) has neuroprotective effects in neurodegenerative diseases. In this study, we investigated the association between serum Li level and Parkinson’s disease induced by 6-hydroxypapamine (6-OHDA) in rats.

6-OHDA was injected into the medial forebrain bundle by stereotoxic surgery. Apomorphine- induced rotational and cylinder tests were carried out before the toxin injection and in the second and sixth weeks thereafter. Blood samples were collected from the heart of the animals in the seventh week. The survival of dopaminergic (DA) neurons in the substantia nigra pars compacta (SNc) was determined using immunohistochemistry. Li was measured by ion selective electrode method (ISE).

There was no significant difference in the serum Li levels between control and 6-OHDA-treated rats. Based on the severity of the rotational behavior, the 6- OHDA- treated rats were divided into two subgroups: symptomatic (with severe behavioral symptoms) and asymptomatic (with no or mild behavioral symptoms). In the symptomatic and asymptomatic subgroups, SNc DA neuronal loss was 83 ± 16% and 45± 10%, respectively. Serum li level in the asymptomatic subgroup was significantly higher than that in the symptomatic subgroup and control group.

Serum Li level increased in the mild to moderate damage to SNc DA neurons but returned to normal value in severe neuronal damage. Therefore, an increase in serum Li level can predict subclinical SNc DA neuronal death and helps in making early diagnosis of PD.

Sertraline is an antidepressant drug and many controversial reports have been presented on the complications of sertraline on the reproductive system. In this study we evaluated the protective effects of vitamin E against sertraline-induced damage to the reproductive system of male mice.

In this experimental study, 40 adult male mice were divided into 8 groups of 5. Four groups received 100 IU/kg.bw vitamin E by gavage for 42 days. One group was considered as control and three groups received just sertraline with doses of 5, 10 and 20 mg/kg.bw orally. 24 hours after the last treatment, testes tissue and blood samples were collected and sent for histochemical and biochemical studies, spermatogenic indices as well as measurement of the expressions of Bcl-2, Caspase-3 and Hsp70-2 genes.

The results showed a significant increase in the level of malondialdehyde, nitric oxide and expression of Caspase-3 and Hsp70-2 genes. We also found a significant decrease in spermatogenesis indices, total antioxidant capacity, testosterone and Bcl-2 gene expression in the group receiving 20 mg/kg.bw sertraline (P<0.05). The above mentioned parameters were improved in the groups that received vitamin E along with sertraline.

Vitamin E can decrease the adverse effects of sertraline on biochemical and histochemical parameters, spermatogenic indices and can increase the expression of Bcl-2, Caspase-3 and Hsp70-2 genes in the testicular tissue of mice.

Nitric oxide is involved in response to stress-induced anxiety and depression in the dorsal hippocampus. In this study we investigated the effects of L-arginine and L-NAME in the dorsal hippocampus on anxiety, depression, and brain-derived neurotrophic factor (BDNF) levels in stressed male NMRI mice.

Electric foot-shock stress (10 Hz, 40 mV for 60 seconds) was applied to animals for four consecutive days. Three doses of L-arginine or L-NAME (1, 5 and 10 μg/mouse) were injected bilaterally into the dorsal hippocampus five minutes before starting foot-shock stress. Anxiety and depression-like behaviors and brain BDNF levels were measured 24 hours after stress using an elevated plus maze, forced swim test, and ELISA, respectively.

Injection of different doses of L-arginine and L-NAME before stress showed that the number of entries in the open arm decreased in elevated plus maze. The number of entries in the closed arm increased more in the stress group than that in the control group. Also, intra dorsal hippocampus injections of different doses of L-arginine and L-NAME before stress significantly decreased swimming time and increased floating and struggling time in the forced swim test compared to the control group. In addition, ELISA results showed that injections of different doses of L-arginine and L-NAME before stress had no significant effects on brain BDNF level.

Nitric oxide in the dorsal hippocampus may mediate the induced anxiety and depression behaviors by foot-shock stress.

Dacryocystorhinostomy (DCR) is one of the most common ophthalmologic surgeries frequently associated with bleeding. Considering lack of a similar study, we decided to evaluate and compare the effects of remifentanil and tranexamic acid on the amount of bleeding during DCR surgery.

This double-blind randomized clinical trial included 162 patients who were candidate for DCR surgery at Feiz Hospital between 2019 and 2020. Patients were selected by gradual random sampling method and randomly divided into three groups receiving either tranexamic acid or remifentanil or normal saline(control group) during surgery. Bleeding rate, hemodynamic variables and duration of surgery were compared among the groups.

The mean volume of intraoperative blood loss was significantly higher in the control group than in the tranexamic acid and remifentanil groups. Also, the mean volume of intra operative blood loss was more in the tranexamic acid group than in the remifentanil group but the difference between the two groups was not significant in this regard(P>0.05). The mean postoperative blood loss was significantly higher in the remifentanil group than that in the tranexamic acid and control groups. Total (intraoperative and postoperative) blood loss was significantly higher in the control group in comparison to the blood loss in the remifentanil and tranexamic acid groups. Also, total blood loss in the remifentanil group was significantly higher than that in the tranexamic acid group (P<0.05). Changes in hemodynamic variables showed no significant differences among the groups.

We found lower amount of bleeding in the tranexamic acid and remifentanil groups compared to that in the control group. We recommend use of these two drugs for reduction of bleeding in the patients undergoing dacriocystorhynostomy. Also tranexamic acid is more effective than remifentanyl in this regard.

Choosing an appropriate anesthetic agent for induction and maintenance of anesthesia is very important in hemodynamic stability and pain control. The aim of this study was to compare the effects of ketamine-remifentanil combination with ketamine-propofol combination on pain, agitation and hemodynamic changes during closed reduction of nasal fracture.

This single-blind clinical trial included 80 patients between 16 and 18 years of age with ASA1 physical status who had undergone closed reduction for nasal fracture. Patients in the group 1 received 0.75 mg/kg ketamine and 2µ/kg remifentanil and group 2 received 0.75 mg/kg ketamine and 1.5 mg/kg propofol to induce anesthesia. Hemodynamic changes (heart rate, systolic and diastolic blood pressure), pain intensity, agitation, as well as nausea and vomiting and changes in arterial hemoglobin oxygen saturation during surgery were evaluated immediately after induction of anesthesia and after surgery every 15 minutes for 2 hours.

Based on the statistical analysis of the patients' data, the mean heart rate and pain intensity scores in the ketamine-remifentanil group were significantly lower than those in the ketamine-propofol group (P <0.05). Mean systolic and diastolic blood pressure and RASS scores in the two groups did not show any statistically significant differences (P> 0.05). The incidence of nausea was higher in the ketamine-remifentanil group and the decrease in oxygen saturation was higher in the ketamine-propofol group (P <0.05). There was no statistically significant difference between the two groups in regard to incidence of vomiting (P> 0.05).

Based on the results of this study, it seems that use of ketamine-remifentanil combination in comparison to ketamine-propofol in closed reduction of nasal fracture is associated with greater hemodynamic stability, higher analgesic effect and fewer complications.

Objective measurement of visual acuity using VEP is high valued in patients with low levels of cooperation. Therefore, this study aimed to investigate the effect of spatial frequency on VEP components in visual acuity using Sweep VEP.

In this cross-sectional study 63 medical students with an age of 22.81 ± 3.93 were selected. After a completed eye examination, refractive error was determined, and best-corrected visual acuity as subjective was recorded by the Freiburg Acuity contrast test. Sweep VEP using the Roland electrophysiology system was recorded for various spatial frequencies from 2 to 37.5 cycles per degree. VEP components were the latencies of N1, P1, N135, and the amplitude of VEP.

Repeated measures of the ANOVA test showed that the effect of spatial frequency on latencies and amplitude of VEP was significant (P<0.001). Paired T-test showed that there was a significant difference between subjective visual acuity and extrapolation of visual acuity with VEP (P<0.001).

According to the significant relationship between VEP amplitude and spatial frequencies of the visual stimuli obtained in this study, the Sweep VEP technique can be used as a valid and objective tool in the determination of visual acuity, especially in patients with low levels of cooperation.

Although MRI is the preferred method with high diagnostic sensitivity for disc herniation, definitive diagnosis based on MRI image interpretation is still a major challenge. The aim of this study was to evaluate the clinical and morphological findings in different MRI sequences and then assessment of the agreement between different observers.

In this descriptive-analytical study, different MRI sequences of 224 patients with disc herniation were analyzed and diagnosed separately by two radiologists. The morphological type of disc herniation and the location of the involved disc were diagnosed and finally, the diagnostic agreement between the observers was assessed.

A total of 224 patients (124 women and 100 men) with disc herniation were included in the study. On average 40% of the cases were bulge, 38% protrusion, 13% extrusion and 9% sequestration. There was complete agreement between the observers in the determination of anatomical location, but in regard to morphological type, we found a kappa agreement coefficient of 0.45 between the observers.

T1 weight sequence is helpful in the diagnosis of the bulging hernia. The agreement between the observers was moderate (k = 0.45) and there was no agreement between the physicians on the morphological level of the extrusion and sequestration hernia. Use of other diagnostic methods besides MRI, integrated and continuous training of methods for interpreting MRI images based on Best Evidence Medical Education are recommended.

Carrying out medical orders is one of the most important parts of treatment and medical errors can cause unrepairable damages. The purpose of this study was to evaluate the frequency of nurses' medical errors and their related factors in Sanandaj teaching hospitals in 2018.

In this descriptive-analytical (cross-sectional) study, we reviewed 400 medical recoreds of the patients in educational hospitals in Sanandaj, during January, February, and  March 2018. Using a department  form consisting of demographic data of nurses (age, gender, occupational experience, working hours during a month and working shifts) and a specific checklist about medical errors including errors in recording drugs, in the spelling of drugs, in recording the exact form of drugs, in recording the exact dosage of administrated drugs, in recording increase or decrease of the dosage, in removing the drugs which had been discontinued. The opinions of the researcher and the nurse who had made the mistake, about the reason of exact error were also included. Data were analyzed by descriptive (frequency and percentage of frequency) and analytic (chi-square) tests.

Medical errors were found in 34 medical records. The most frequent errors occurred in the morning shifts (79.4 %), in the female gender (76.5 %), in the age group between  20 and 30 years of age in the nurses with occupational experience of less than 5 years, and in those who worked 100 to 200 hours/month (61.8) . The number of medical errors had significant relationships with occupational experience, age group, and working hours of the nurses.

Most mistakes were made by nurses who beared a heaver workload or had occupational experience of less than 5 years. Regarding the results of this study, in order to reduce the medical errors in the hospitals, the workload of nurses should be reduced and nurses with little experience should work under close supervision of the experienced nurses.

Antibiotic resistance is considered a global and increasing threat to human health. Excessive use of antibiotics is one of the leading causes of antibiotic resistance. In this study, we investigated the frequency of antibiotic prescriptions and evaluated the aspects of its prescription in Sanandaj hospitals.

This study was part of the Global-PPS Antibiotic Consumption and Resistance Project under the management of the University of Antwerp, Belgium, in 2016 and 2018, the purpose of which was to help improvement of the rational prescription of antibiotics in hospitalized patients. The study method was based on the protocol developed by the global point prevalence survey project. All patients hospitalized in the neonatal, pediatric, and adult departments of Besat, Tohid, Kowsar, and Social Security hospitals in Sanandaj were included on the selected study days.

Quality indicators of antibiotic prescription in children and adults departments consisted of the relative frequency of antibiotic prescription (57.84% and 42.57%), the relative frequency of combined treatment prescription (73.41% and 50%), use of experimental treatment vs. Targeted treatment based on microbiology evidence (4% and 2%), reference to hospital guidelines in prescribing antibiotics (3% and zero), the presence of a registered indication for prescribing antibiotic treatment (79% and 49%), and also stop/review date documented in the patient's records (1% and 2%) respectively. The quality indicators in this study were compared with those in the European and other Asian countries.

The quality indicators of antibiotic prescription in Sanandaj hospitals were not favorable compared to the hospitals in European and other Asian countries and indicated an urgent need for intervention by designing an antibiotic stewardship program.

Considering the potential impact of health literacy on strengthening the health belief model and also the role of health literacy in adopting preventive behaviors and the role of health volunteers in transmitting health messages to the community, this study aimed to assess the structures of the health belief model combined with health literacy in predicting the adoption of osteoporosis preventive nutritional behaviors among health volunteers.

In an analytical cross-sectional study, 290 active health volunteers referring to health centers in Qazvin in 1399 were selected through multi-stage random sampling to participate in the study. Data collection tools included a standard questionnaire based on the Health Belief Model, Iranian Adult Health Literacy Assessment Tool (HELIA), and a questionnaire to assess the adoption of osteoporosis preventive nutritional behaviors. Using SPSS software version 23, data were analyzed by descriptive statistics, Pearson correlation coefficient, and multiple regression tests.

The mean and standard deviation of health literacy and adoption of preventive eating behaviors scores were 65.47 ± 12.54 and 6.104 ± 1.417, respectively. Multiple regression test showed the constructs of perceived barriers (P = 0.026, β = -0.155), self-efficacy (P = 0.009, β = 0.317) and health literacy (P = 0.016, β = 0.259) were predictors of osteoporosis-preventive nutritional behaviors. Together, these variables were able to predict 37.8% of behavioral changes.

The integrated health belief model with health literacy can be used as a suitable framework for designing educational interventions to encourage health volunteers to adopt preventive nutritional behaviors from osteoporosis.