مجله دانشگاه علوم پزشکی بابل
سال پانزدهم شماره 6 (پیاپی 75، آبان 1392)

Given the importance of blood glucose regulation in prevention of diabetic complications and considering the fact that the patients tend to eat foods that reduce blood sugar، the main objective of this study was to determine the effect of apple cider vinegar on postprandial blood glucose in patients with type 2 diabetes.

In this clinical trial study، thirty type 2 diabetic patients randomly divided in two groups (each group 15 patients). In fasting condition case group received combine apple cider vinegar، 20 gr and 40 gr of water and control group received 40 gr water and immediately، both groups were given breakfast containing 58 grams of carbohydrate. The cross-over trial was conducted after 1 week wash out. Blood samples were collected at fasting and 90 min post breakfast for glucose and insulin analysis. (IRCT: 201201078630N1)

Mean (±SE) changes in blood glucose while using apple cider vinegar versus placebo respectively was 118. 7±10. 31mg/dl، 106. 9±10. 37mg/dl. Mean (±SE) changes of insulin level when using vinegar was 23. 1±3. 69? u/ml versus17. 3±3. 39? u/ml when using placebo. There were no significant differences between two groups.

Although results of this study showed that apple cider vinegar has no effects on postprandial plasma glucose and insulin.

Reduction in the number of salivary streptococcus mutans، leads to reducing the caries score. The probiotics are effective in achieving this purpose. The aim of this study was to compare the effect of probiotic yogurt-drink Kefir، 0. 2% sodium fluoride and 0. 2% chlorhexidine mouthwashes on the growth of streptococcus mutans. In this experimental study، microbial suspension from a standard strain of streptococcus mutans PTCC 1683 and 7 isolated salivary strains were inoculated on BHI plates. Two wells were inserted in each plate، one containing the 0. 2% sodium fluoride or 0. 2% chlorhexidine mouthwashes or drink Kefir or 20mg/ml penicillin solution (positive control) and the other contained distilled water (negative control). The inhibition zone around each well was measured after incubation. To determine the minimum inhibitory concentration، in turbidity measurement method، the chlorhexidine، Kefir and penicillin solutions were diluted serially so microbial suspension was added to them. The turbidities of the solutions before and after incubation were measured by ELIZA reader 2 and the minimum concentration with antibacterial effect was reported. There was not halo around the sodium fluoride. The mean diameter of halos for penicillin، chlorhexidine and Kefir was 43. 29 ±4. 68، 27. 38±3. 39 and 19. 88±5. 62 mm، respectively. These differences between all groups two by two were significant (p? 0. 0001). The minimum inhibitory concentration of penicillin، chlorhexidine and Kefir was recorded at the range of 3. 125 - 6. 25%، 6. 25 - 25% and 25 - 50%، respectively. The results of this study showed that Kefir was able to inhibit the Streptococcus mutans more than 0. 2% sodium fluoride but less than 0. 2% chlorhexidine.

A different forms of morphine (intravenous، oral، intramuscular) are used in control of pain after surgeries. Morphine Sulfate rectal suppository is a new form of this drug. The aim of this study was to compare the effect of morphine as two methods، intravenous morphine (Patient-Controlled Analgesia، PCA) and Morphine Sulfate rectal suppository in control of postoperative pain. In a double-blind controlled clinical trial، 60 patients (18-65 years old) undergoing hip or knee arthroplasty enrolled in this study. They were randomly divided into two groups: A and B. Group A received intravenous morphine (PCA) while the second group received rectal morphine suppository (10mg). Pain intensity assessed by using visual analogue scale (VAS) and verbal pain score. Data was collected using the questionnaire. The prepared questionnaire is used for evaluation of patient satisfaction (completely satisfied، satisfied، no comments، dissatisfied، completely dissatisfied). The number of nausea and vomiting، drowsiness and hamodynamic variables were also evaluated and compared. Mean of pain intensity after 24 hours in PCA group (1. 50±0. 97) in compared to morphine suppository group (1. 57±1. 33) was not significantly different. So in group A، 56. 7% was completely satisfied in compared to 48. 3% in group B (p=0. 3). Nausea and vomiting occurred in 5 patients in group B (16. 7%) but in group A any patient did not have nausea and vomiting (p=0. 026). In this study، postoperative pain was controlled similar in two groups. Although، postoperative nausea and vomiting was more common in suppository group.

Considering the increasing of fungal infections، including Aspergillosis and with the development of fungal drug resistance، many researchers focus on the antifungal properties of plant essences. The aim of this study was to evaluate the inhibition and destruction effects of Cuminum cyminum، Ziziphora clinopodioides and Nigella sativa essences on aspergillus cells. In this experimental study، the first group was included of each one of the Cuminum cyminum، Ziziphora clinopodioides and Nigella sativa essences as case group، and the second group of the study was included of positive and negative control group. The essences were extracted by hydro-distillation procedure. Then، by applying Broth Macro Dilution and Broth Micro Dilution techniques and four times of repetitions، the mean of Minimum Inhibitory Concentration (MIC90) and Minimum Fungicidal Concentration (MFC) of the above-mentioned essences were certified against Aspergillus fumigatus (ATCC 16913) and Aspergillus parasiticus (ATCC 115201) in Broth Macro Dilution and Broth Micro Dilution techniques، in 0. 25، 0. 5، 1، 1. 5، 2، 2. 5، 3 and 0. 5، 0. 75، 1، 1. 25، 1. 5، 2، 2. 5، 3، 4، 5، 6 and 8 concentrations (mg/mlit)، respectively. Analysis of chemical compositions of the essences was performed by using gas chromatography linked to mass spectrometer (Gc/Ms). The effects of above-mentioned essences on cellular structure of aspergillus species were examined by transmission electron microscopy (TEM). Based on broth macro dilution technique and 4 times of repetitions، the mean of MIC90 and MFC of Cuminum cyminum، Ziziphora clinopodioides، and Nigella sativa essences on both of aspergillus species، were 0. 31، 0. 40، 1. 50 mg/ml، and 0. 75، 1. 28، 2. 25 mg/ml، respectively. The same arrangement of the above-mentioned essences effect was also confirmed by broth micro dilution technique. The statistical tests showed a significant correlation between inhibition and destruction effects of essences used in this study (p=0. 017). Considering the analysis، the main constituent of C. cyminum oil was? - pinene (30%)، in Z. clinopodioides oil was pulegone (37%)، and in N. sativa oil it was transanethole (38. 9%). The main pathologic changes were observed by TEM were in the cell wall، plasma membrane and membranous organelles. The findings of this study showed that Cminum cyminum، Ziziphora clinopodioides and Nigella sativa had appropriate fungistatical and fungicidal functions against Aspergillus fumigatus and Aspergillus parasiticus.

Pain is an unpleasant sensation and emotional experience that associated with actual or potential tissue damage. Anti-inflammation and antinociceptive drugs، because of their side effects and in some cases insufficient effects are useless so it seems that finding other more effective drugs is necessary. The present study was designed to evaluate the antinociceptive effect of hydroalcoholic leaf extract of Tribulus terrestris (HET) in male rats. In this experimental study، 36 male rats were divided into 6 groups including the control group (normal saline)، morphine group (1mg/kg، i. p.)، HET group (50، 100، 200mg/kg، i. p.) and the group treated with naloxone (1mg/kg) with extract (200mg/kg) of body weight was used. To evaluate the antinociceptive effect of HET writhing، tail flick and formalin test were used. HET (200mg/kg) significantly reduced pain in writhing، tail flick (p<0. 01) and formalin tests (p<0. 001). There was no significant difference between the morphine and HET (200mg/kg) groups in the chronic phase of formalin. From the results it could be concluded that the HET extract exhibit antinociceptive activity.

Morphine is the most effective pain-relieving drugs in the management of pain. Morphine modulates survival and apoptosis of neural and tumoral cells. Some data suggest that morphine induces apoptosis in neurons, while other evidence shows that morphine could have beneficial effects against apoptosis. The present study was undertaken to evaluate the effects of different concentrations of morphine on serum deprivation-induced cell death in PC12 cells

In this study PC12 cells (Pastour Insititue, Iran) were cultured in RPMI1640 culture medium supplemented with 0.2% BSA. Cells were divided to 2 groups (group I: cells unpretreated with naltrexone; group II: cells pretreated with naltrexone). There were six treatments in each group. Cells treated with different concentrations (The treatments were: treatment1: 10-12, treatment 2: 10-10, treatment 3: 10-8, treatment 4: 10-6, treatment 5: 10-4, Treatment 6: 0.0 M,) of morphine. The percentage of cytotoxicity by lactate dehydrogenase assay and the percentage of cell death by Hoechst/PI differential staining of each group were assessed.

After 6 days, serum deprivation result in full cell death (100%) in PC12 cells (p<0.05). The percentage of cytotoxicity and cell death assessment showed that morphine at different concentration inhibited serum deprivation-induced cell death and cytotoxicity in PC12 cells (p<0.05).

Our results concluded that morphine with an opioid receptor-depended as a growth factor lead to inhibition of serum deprivation-induced cell death in PC12 cells.

When vaginal delivery endangers the life of the mother or newborn، cesarean section can be used. Nowdays، CS rates have continuously rising among pregnant women while in many cases it is not necessary to be performed. The purpose of this study was to identify the effective factors for choosing the delivery method in primiparous women in Babol، Iran.

This cross-sectional study was conducted on 360 nulliparous women (180 cesarean section and 180 vaginal deliveries) who were admitted at all health centers in Babol in 2010. Researcher made questionnaire including demographic information، questions about the reasons for choosing cesarean and vaginal delivery and etc were completed by interview.

The mean age of the individuals was 27±4. 8. Major reason declared by mothers in the elective cesarean group was fear of pain (62%) and in group with vaginal delivery، the more common reason was fear of cesarean section complications (52. 8%). In obligative group، major medical indication was prolonged labor (26. 8%).

According to the results of this study، fear of pain was the major reason for choosing cesarean. It is recommended that training women about the risks and benefits of each type of delivery

Malnutrition is a serious medical condition marked by a deficiency of energy، essential protein، fats، vitamins and mineral in a diet. Malnutrition causes a high rate of childhood morbidity and mortality in the world. The aim of this study was to assess the effective factors (anthropometrics) on malnutrition in infants of Babol، Iran. This cross-sectional study was performed on 782 infants from six medical health centers in Babol. Data were gathered by using a questionnaire including demographic and anthropometric information، family characteristics and kind of nutrition. In this study، the height، weight and age measurement was used to evaluate the nutrition condition. NCHS (National Center for Health Statistics) reference which confirmed by WHO were used to compare these measurements. From 782 infants، 370 (47. 3%) were female and 412 (52. 7%) were male. 250 infants (89. 9%) under 6 months were fed with breast milk and 349 (69. 8%) infants above 6 months fed with breast milk and supplementary feeding. 5. 4% of female and 0. 5% of male infants were underweight، 4. 6% of female and 1% of male infants were stunting، and wasting observed in 10. 4% of female and 3. 9% of male infants. Gender had a relationship with underweight (p=0. 000)، wasting (p=0. 000) and stunting (p=0. 002). There was also a significant relationship between birth weight and underweight (p=0. 006) and stunting (p=0. 000) In this study the infants had mild malnutrition based on growth indices. This study showed that the infants had mild malnutrition. So، promoting family awareness about different factors causing malnutrition، family education، family support and nutritional support are recommended

Bronchiolitis is a lower respiratory tract infection which is prevalent in children younger than 2 years. The use of chest radiography for diagnose of bronchiolitis is controversial. This study aimed at determining the radiological findings in children with bronchiolitis who were admitted to Amirkola children hospital and two radiologists consistency. This cross-sectional study was performed on 165 children with 2-24 months old admitted to Amirkola children hospital with bronchiolitis in 2011 and 2012. Inclusion criterion was the first episode of bronchiolitis. Bronchiolitis diagnosis was based on patient history and physical examination and presence of wheezing in the first 7 days of illness. Other data were recorded including age، sex، axillary temperature on admission to the emergency room، crackles and the score of Respiratory Distress Assessment Instrument (RDAI) for detection of severity of bronchiolitis. The scale had zero to 17 score that had a score of 5 or less as the mild bronchiolitis and 6 or more were considered as severe bronchiolitis. Chest radiography in posterior-anterior position was done in all patients and it was reviewed by two radiologists. Of 165 patients، 69 (41. 8%) were female. The mean age of children was 7. 3±5. 6 months. Sixty-six (40%) of children had Crackles. 74. 5% of the subjects were taking antibiotics during hospitalizations. 19. 4% were treated as outpatients and 80. 6% of children were hospitalized. The mean and standard deviation of RDAI score of children with bronchiolitis was 6. 7±2. 8 and 51. 5% had severe bronchiolitis. Ninety eight children had increased pulmonary markers and peribronchial infiltration and 56 children had complex findings in both radiologists'' reports. In 93. 3% of cases the findings reported by two radiologists were the same. Results showed that radiography was not necessary in children with acute bronchiolitis and these findings were compatible with clinical diagnosis.

The most effective way to reach a correct diagnosis in the oral lesions with similar clinical features is doing an appropriate biopsy from lesion and histopathological evaluation of it. The purpose of this study was to evaluate the concordance and non-concordance between clinical diagnosis and pathology reports of patients referred to department of oral and maxillofacial pathology of dental school in Babol، Iran.

This cross sectional study was performed on 662 patients'' records from the archive of oral and maxillofacial pathology department of Babol dental school to determine the concordance between clinical diagnosis and histopathological diagnosis of oral lesions during the years 2003-2010. Demographic information such as age and gender of patients، the color and consistency of lesion، anatomical location، biological process and appearance of lesions، peripheral or central، exophytic or flat lesions، specialty of physician، concordance between clinical and histopathological diagnosis was extracted from patients'' records.

There was concordance in 79% of cases in correct clinical diagnosis according to the first priority in differential diagnosis. The most of correct clinical diagnosis (94%) has been in third decade of life. The most of correct clinical diagnosis has been in gingiva (100%). Correct clinical diagnosis in the benign lesions (94. 3%) was more than malignant lesions (90. 9%) and the correct clinical diagnosis for exophytic lesions was more than other lesions (94%). Correlation coefficient for determine of concordance between clinical and pathological diagnoses was obtained as 80. 0% (p=0. 018).

Although a great concordance was observed between clinical and pathology reports، the inconcordance was significant.

Infertility is an individual and a social problem that affects the infertile couple''s life and family functioning and may expose them to mental disorders or stress. The aim of this study was to compare the depression and life quality of fertile women and those who suffer from infertility and frequent abortions. In this cross sectional study، 30 participants with at least 3 year infertility، 30 participants with at least 2 frequent abortions from medical centers clients and 30 fertile participants who were available in Kerman city، Iran in the first half of the year 2012 were chosen. Data was gathered by using Beck depression and the quality of life questionnaires، the lowest achieved score was 12 for quality of life and 5 for depression and the highest achieved score for quality of life was 48 and for depression was 61. Then gathered data was compared. Depression in women with frequent abortions (36. 70±14. 28) was more than infertile (24. 07±6. 16) and fertile women (15. 90±11. 13). Also life quality of fertile women (34. 67±7. 02) was more than women with frequent abortions (23. 03±7. 53) and infertile women (21. 23±7. 05). There was a significant difference among these groups in two indicators (p<0. 001). The results showed that women suffering from infertility and frequent abortions have higher depression score and lower quality of life score than infertile women

Splenectomy considered as second line therapy in management of patients with idiopathic thrombocytopenic purpura (ITP) whom did not respond to corticosteroid or the platelet decreased after corticosteroid cessation. The aim of the present study was to determine the response to splenectomy in chronic ITP patients. This retrospective cohort study was performed on all patients with ITP who underwent splenectomy at Shahid Beheshti and Yahyanejad hospitals during 10 years. Age، sex، time of initial treatment، time of surgery، platelet counts at time of diagnosis، pre- and post-operative platelet counts، respond to treatment and receiving treatment، extracted from the patient''s registry. From 41 patients، the immediate postoperative response was partial in 4 patients (9. 8%) and complete in 37 patients (90. 2%). Non-response was not seen in any patient. The median follow-up was 12 months (range: 1-101 months). In long-term follow up، complete response (CR) was achieved in 4 patients (85. 3%) and partial response was achieved in 2 (%4. 9) of patients and treatment failure was achieved in 4 patients (9. 8%). According to the results of this study، many of patients with ITP who underwent splenectomy have long term remission and splenectomy is a safe and effective method of treatment for these patients.

As an important achievement in industrialization and urbanization، depression can be much related to the oral hygiene especially periodontal indexes which are a symbol of tooth and oral hygiene and their surrounding tissues. The purpose of this study was to compare the periodontal indexes in individuals with and without depression disorders.

The present study was carried out in the form of a questionnaire، examination، and recording in the information form. The subjects were divided into two groups of 50; a group included the patients suffering from depression who hospitalized in Neuropsychology ward of Panje Azar hospital in Gorgan، Iran and the control group included either the patients who referred to department of oral medicine and diagnosis of Babol dental school or the people accompanying the patients who had claimed to have no history of depression. The periodontal indexes of the study included: Silness and Loe plaque index، Loe gingival index، pocket depth analysis، as well as bleeding on probing. The information related to each patient was recorded in the form and then two groups were compared.

In the present study، the pocket probing were 2. 7692±0. 5991 and 2. 2917±0. 4643 in the control and case groups، respectively (p= 0. 009). The Plaque Index means were 1. 5385±0. 1 and 7763. 2593±0. 5257 in the control and case groups، respectively. Furthermore، the GI and BOP difference between the two groups were not significant. Moreover، there was no significant relationship between the mean of all the analyzed indexes and the increase of depression.

The results of the present study indicate a vivid relationship between the depth of pocket probing and depression. Nevertheless، none of the periodontal indexes were obviously related to the degree of depression.

Stroke is the third leading cause of death in the world. Risk factors for stroke in young adults are different from adults، this study aimed to determine the frequency and risk factors for strokes in patients 15-45 years old. In this cross-sectional study، hospital records of all patients 15-45 years old with stroke who were hospitalized in Ayatollah Roohani hospital during 2009-2010 by using a checklist including demographic characteristics، time of stroke onset، type of stroke and risk factors were extracted and the collected data were analyzed. The average age of patients was 38. 09±6. 11 years that 34 patients (52. 3%) were male and the rest were female. The most common type of stroke was ischemic in 61 cases (93. 8%)، that the most common of them was embolic in 38 (58. 8%) and hemorrhagic strokes (6. 2%)، and 10. 8 % were as a TIA (transient ischemic attack). Among the risk factors، hypertension was in 23 cases (35. 4%)، heart disease was in 20 cases (30. 8%) including ischemic heart disease in 7 cases (%10. 8)، mitral stenosis، patent foramen ovale each in 6 cases (9. 2%) and the others were different other cardiologic etiologies. Alcohol and substance abuse in 18 cases (28. 1%)، hyperlipidemia in 15 cases (23. 1%)، diabetes in 13 patients (20%)، hematologic disorders in 12 cases (18. 5%) that 6 cases (9. 2%) of them had hypercoagulable state. Miscellaneous causes were in 13. 8% cases and no risk factor found in 7. 7% cases. The most common type of stroke was ischemic stroke and hypertension، cardiovascular disorders، drug and alcohol abuse، hyperlipidemia and diabetes were the most common risk factors associated with stroke.

Spontaneous splenic rupture is rare in pregnancy and puerperium، and if the diagnosis and treatment are delayed، maternal mortality and morbidity rates remain extremely high. In this article a case of a spontaneous splenic rupture following cesarean section is reportedCASE: A 24-year-old healthy woman had elective cesarean because of twin pregnancy at 38 weeks of pregnancy. She was reexplored for hemorrhagic shock on her first postpartum day. Urgent laparotomy revealed hemoperitoneum due to splenic vein rupture. Uterus and adnexa were normal and splenectomy was performed. The patient was not traumatized during surgery or postoperatively and microscopic examination of spleen was normal. However spontaneous splenic rupture is a rare event، it should be suspected in any women with unexplained abdominal pain or with signs of internal bleeding during pregnancy or early postpartum.

Donohue syndrome (Leprechaunism) is the most severe form of insulin resistance syndromes which is characterized due to specific symptoms. Congenital hypothyroidism is the most common reason of mental retardation while the normal neurological development can be provided by early and effective treatment. In this article، a case with Donohue syndrome and central hypothyroidism is reported. CASE: A 28 day old male newborn with clinical features of Donohue syndrome had fasting hypoglycemia، postprandial hyperglycemia، extreme hyperinsulinemia and low serum T4 and FT4، with lower limit TSH and T3U. Blood glucose was controlled and hypothyroidism was treated. The patient died one month after discharge In infants with Donohue syndrome، despite normal screening test for hypothyroidism، comprehensive thyroid function test is recommended.