مجله دانشگاه علوم پزشکی مازندران
پیاپی 106 (آبان 1392)

Background and Major pathologic cause of abortions is unknown. HLA-G4 and HLA-G5 are two isoforms, membrane (G4) and soluble (G5) of nonclassical molecules of HLA-1b that can induce tolerance between mother and fetus. In this study, expression of two HLA-G isoforms and their effect were evaluated in threatened-abortion women in comparison with controls. In a case-control study, 101 threatened-abortion women and 101 health pregnant women in the age range of 20-32 years were studied for expression level of two HLA-G4 and HLA-G5 isoforms after RNA extraction and cDNA synthesize with use of real-time polymerase chain reaction (Real-time PCR) procedure. The expression of HLA-G4 and G5 were significantly decreased in threatened–abortion women in comparison with controls (P < 0.0001). In addition, HLA-G5 higher than HLA-G4 decreased in threatened- abortion women (P = 0.0001). Furthermore, senile had direct effect in high abortion risk and low expression level of HLA-G4. According to our findings, HLA-G5 is affecting molecule in fetus maintenance in comparison with HLA-G4 during pregnancy. Thus, it is proposed to evaluate this molecule before twenty weeks in pregnancy as a prognosis factor for prevention of fetus loss.

Background and

Several studies have mentioned the prevalence of chronic tinnitus in the communities and its adverse effects on the patients’ quality of life. Although no cure for this condition has been found, the use of drugs, benzodiazepines and antihistamines, is common among the current treatments. This study compared the effects of alprazolam and cinnarizine therapy in patients with idiopathic tinnitus.

This clinical trial study was done on 101 patients with idiopathic tinnitus. Patients were randomly divided into two groups and 15 days were treated with alprazolam and cinnarizine. The study data were analyzed using the SPSS software at the significant level of less than 0.05.

Mean age of patients was 45.50 ± 12.40 years, ranged from 20 to 75 years. 67.3% (68) of patients were women and 32.7% (33) were men. The cure rate after treatment was 0% in alprazolam and 2.3% in cinnarizine groups, respectively. The rates of partial remission and drowsiness in alprazolam and cinnarizine groups were 47.7% and 43.2%, and 68.4% and 31.6%, respectively.

Alprazolam and cinnarizine are equally effective in the treatment of idiopathic tinnitus. Nevertheless, as the side effect of drowsiness was more in the alprazolam, it is preferable in terms of cinnarizine.

Background and

CYP1B1 is involved in the metabolism of exogenous and endogenous substrates and plays a key role in hormone and xenobiotic induced carcinogenesis. Polymorphisms in CYP1B1 could result in modifications in its enzyme activity and are known to be associated with cancer susceptibility related to environmental toxins and hormone exposure. Moreover, the association of CYP1B1 polymorphisms with glaucoma has been reported. In the present study, we determined the frequency of Leu432Val (G4326C) polymorphism of this gene in a healthy population from Mazandaran province of Iran.

A total of 150 unrelated healthy subjects from Mazandaran province, residing in Sari, coming for blood donating at Sari Blood Transfusion Center were enrolled. A total of 5 ml of peripheral blood was taken from individuals. Genomic DNA was extracted using DNG+Blood DNA kit. The polymerase chain reaction–restriction fragmentlength polymorphism method was used for the detection of G4326C single nucleotide polymorphism in each subject.

The frequencies of the GG (Val/Val), CG (Leu /Val) and CC (Leu/Leu) genotypes were as 12%, 40.7% and 47.3%, respectively (P < 0.05). The frequency of G allele in Iranian population (Mazandaran province, Sari) was 32.3% and the frequency of C allele was 67.7%.

Results of the present study might be important in understanding the distribution of Leu432Val CYP1B1 polymorphism in the Mazandaran province of Iran. Moreover, these results could be helpful in predicting the risk of cancer and glaucoma.

Background and Androgentic alopecia (AGA) is physiological hair loss induced by androgens in genetically predisposed persons. Different medications have been suggested to treat AGA until now but there is no certain treatment. This study aimed to compare the effect of caffeine + minoxidil topical solution 2.5% and minoxidil topical solution 2.5% in AGA treatment. In this double-blind randomized clinical trial study 60 patients were enrolled. The sampling method was simple classification and patients were divided to 2 equal groups. The first group received minoxidil topical solution 2.5% and the second group received caffeine + minoxidil topical solution 2.5%. Method of treatment was the same in both groups (one milliliter of solution was applied twice a day) and follow-up was by computation of hair numbers on alopecia area in scalp. Both groups were followed in 7 stages: at the beginning of study and the days 7, 30, 60, 90, 120, and 150. Caffeine + minoxidil topical solution 2.5% was more effective than minoxidil topical solution 2.5%. There was a significant statistical difference between the groups. This study overtly showed that the effect of caffeine + minoxidil topical solution 2.5% to treat AGA was better than minoxidil topical solution 2.5%. We suggest more studies with greater sample size and longer priod of follow-up.

Background and Diagnostic services are very important as inherent part of modern medical care; about 70% of medical diagnoses are made based on their results. This study aimed to evaluate the effect of household income, geographical access, out of pocket, physician's visits and hospitalization of Iranian Social Security Organization-insured patients on the utilization of laboratory and imaging services. In analytical study, the Iranian Social Security Organization database in each province in the period of 1998-2011 was searched. Study population included 24 million people covered by this organization ferred to the direct and indirect treatment sectors for laboratory and imaging services over these years. To estimate the model the fixed effects logarithmic regression via the Eviews software was used. The following factors had a significant effect on the utilization of laboratory and imaging facilities: geographical access to the laboratory (β = 0.31) and imaging (β = 0.50) facilities, household income on the utilization of the laboratory (β = 0.24) and imaging (β = 0.43) services, outpatient visits on the utilization of the laboratory (β = 0.56) and imaging (β = 0.43) services, and inpatient services on the utilization of the laboratory (β = 0.35) and imaging (β = 0.51) services. Also, amount of out of pocket for using the mentioned services and referral burden of inpatient and outpatient for direct treatment had no significant relation with utilization of the services. If policymakers exclusively pay attention to the out of pocket, they cannot provide the appropriate utilization of services. Sometimes, to set the used utilizations, the channels such as commands of general practitioners or specialist and/or geographical access are often forgotten.

Background and Zinc (Zn), copper (Cu) and iron (Fe) are essential minerals required for a variety of biomolecules to maintain the normal structure, function, and proliferation of cells. Abnormal metabolism of heavy metals can lead to several chronic pathogenesis. In this study, two new saccharin hydrazide derivatives were synthesized and their chelatory activities were evaluated. Acetic acid ethyl ester and propionic acid ethyl ester derivatives of saccharin were synthesized by the reaction of the starting materials (saccharin) with ethyl bromoacetate and ethyl bromopropionate under the reflux condition and using the dimethylformamide (DMF) as solvent. Ester compounds were stirred with hydrazine hydrate in ethanol and then the products were isolated. The desired hydrazide compounds were purified by thin layer chromatoghraphy. The ultraviolet (UV) spectra of hydrazide products in the absence and presence of ethylenediaminetetraacetic acid (EDTA) were obtained in order to the analysis of chelating activity with Fe2+ and Fe3+, Zn, Cu and alluminium (Al). All products were determined by analytical methods [nuclear magnetic resonance (NMR) and infrared (IR) spectroscopy]. Crystallization method was used for purification of compounds. The reactions’ yields obtained 44 to 46%. Compounds showed good chelatory activites against Fe3+. In presence of EDTA, the reaction of complex production returned back to previous state which suggested less chelating power of the compound. Overall, saccharin derivatives had the ability to chelate Fe3+ more efficient than that of other metals.

Background and Cardiac rehabilitation is an effective strategy to reduce complications of surgery for the patients undergone coronary artery bypass graft (CABG). The aim of this study was awareness of patient perceptions of cardiac rehabilitation after CABG to get better understanding about the nature of program, and its positive and negative aspects in order to reinforce its effectiveness. In this conventional qualitative content analysis, the samples were 19 post-CABG operation patients participated in cardiac rehabilitation programs in Center of Cardiac Rehabilitation in Guilan, Iran. Data collection was performed through unstructured interviews and purposive sampling. Data analysis accomplished according proposed steps by Graneheim and Lundman (2004). Scientific accuracy and integrity of the data and research ethics were respected. The data analysis revealed 4 main categories and 11 sub categories were named as a conceptual and abstract based on their nature: stress of disease diagnosis (fear of surgery and death, concern on post-surgery disability, and high cost of treatment), in search of adoption (family support, the desire to empowerment, and religious-faith beliefs), rearrangement of life (physical fitness promotion, hope to life, and return to society), and the factors affecting to participation in cardiac rehabilitation (barriers to participation in cardiac rehabilitation and facilitators to participation in cardiac rehabilitation). Based on patients perception that showed promote physical fitness, hope to life, and return to society, the significance of the program for patients and need to more effective strategies to facilitate their participation were confirmed.

Background and Ulcerative colitis (UC), a subtype of inflammatory bowel diseases (IBD), is an immune-mediated chronic intestinal condition. Changes in the copper (Cu) and zinc (Zn) concentrations have been reported previously in IBD. Due to controversial results, the aim of this study was to evaluate and compare serum and urine levels of Zn and Cu in patients with UC and control group. This case-control study was conducted on 50 patients with UC and 49 healthy volunteers. Urine and venous blood samples were collected from patients and healthy volunteers and separated serum and urine samples were kept at -20oC. Levels of Zn and Cu were measured in blood serum and urine using atomic absorption spectrophotometry. Data were analyzed then. Mean serum levels of Zn and Cu in patients with UC were 72.6 ± 15.2 and 138.3 ± 42.6 μg/dl, respectively; the values in normal individuals were 104.0 ± 37.9 and 110.0 ± 38.5 μg/dl, respectively. Mean urine levels of Zn and Cu in UC patients were 128.7 ± 37.5 and 8.7 ± 2.3 μg/dl, respectively; in normal individuals, the values were 109.0 ± 34.0 and 4.1 ± 1.5 μg/dl, respectively. The differences between the two groups were significant (P < 0.01). In patients, the overall mean Zn concentration in serum was lower and in urine was greater than the controls. The serum and urine Cu concentrations were higher in those with UC. According to the results, trace element levels such as Zn and Cu in patients with UC are subjects to change. As UC is an inflammatory disease and Cu levels are increased during inflammation, serum and urinary Cu levels were higher. The decrease in serum and increase urinary Zn in patients with UC is debatable. So, for future studies, Zn supplementation and examining mucosal healing process is suggested.

Previous studies have reported a relatively high incidence of total and subtotal thyroidectomy complications in Iran. Fear of this complication has led some internists and patients to avoid thyroid surgery. The aim of study was to determine the recent decade frequency of total and subtotal thyroidectomy complications in Sari, Iran.

In this cross-sectional study, the patients underwent total or subtotal thyroidectomy during 2001-2011 at two referral hospitals in sari (Imam Khomeini as academic and Shafa as private hospital) were enrolled. The questionnaire included demographic information, diagnosis and pathology of the disease, type of thyroid surgery, serum calcium level after the surgery, recurrent laryngeal nerve injury, and hematoma data. Frequencies, Odds ratio and their 95%CI were reported.

Among the 382 subjects (66 men and 316 women), 86 cases (22.5%) underwent total and 296 cases (77.5%) underwent subtotal thyroidectomy. The final pathology was malignant in 25.1%. Hypocalcaemia occurred in 40.3% of patients (CI95%: 35.5-45.3) that 4.2% (CI95%: 2.3-6.6) were permanent. Recurrent laryngeal nerve injury was reported in 0.8% (CI95%: 0.3-2.3) [0.3% permanent (CI95%: 0.05-1.5)] and two cases (0.5%) complicated by cervical hematoma (CI95%: 0.1-1.9). Total thyroidectomy was associated with more complications than subtotal. [OR: 6.4 (CI95%: 2.6-16.1), P = 0.0001].

The findings of this study show that total and subtotal thyroidectomy complications has significantly decreased that can be due to improved surgical techniques and increased proficiency of surgeons.

Background and Intrauterine device (IUD) is one of the modern methods of contraception; one of the problems in using this method is its early removal. This study aimed to determine one-year survival rate and discontinuation causes of IUD use in Kermanshah, Iran. In this cohort study, data were collected from patients with IUD using a questionnaire containing demographic and IUD related variables. Patients were followed for one year or until the time that IUD removed. Then, the data were analyzed using Cox regression model. Kaplan-Meier method was used to determine the duration of IUD use. The mean age of the 274 studied women was 28.2 ± 6.2 years. 15% of them had removed their IUD and the most common reason for withdrawal was related to bleeding and spontaneous removal. The highest IUD removal rate was occurred in the first 6 months and the mean duration of IUD use in people who had IUD removal was 4.2 ± 3.8 months. A significant correlation was found between previously used of IUD and IUD removal. So that, those who did not have a history of IUD use have a greater rate ratio (P = 0.04). In this study, the 6-month survival rate of IUD was 88.7% and one-year survival was 85%. The results show that bleeding and spontaneous removal is the main reasons for discontinuation of this method; therefore, it is necessary to devise strategies to reduce removal rate and increase the time maintenance of IUD.

Background and Indirect electro-oxidation method with H2O2 electrogeneration is an electrochemical process for wastewater treatment based on the production of hydroxyl radicals by means of H2O2 generation in the presence of transition metals such as copper. The electrogenerated hydrogen peroxide process was performed in an open and undivided cell to be assessed for degradation of real textile wastewater using graphite felt (cathode) and Pt (anode) in the presence of copper ions. The effect of major parameters such as dissolved oxygen concentration, initial pH, applied current, copper concentration and time reaction on the decolorization was investigated. 67.9% decolorization and 56.3% chemical oxygen demand (COD) removal were achieved after 210 minutes reaction under the conditions 7.8-7.9 mg/l dissolved oxygen, 250 mA applied current, 7 mM copper concentration and pH=4. The electrogenrated H2O2 process in presence of copper ions could degrade real textile wastewater. Moreover, due to generation of hydrogen peroxide, this process can be economically important.

Background and The irrigation fluid that routinely used during percutaneous nephrolithotomy (PCNL) has systemic absorption. The aim of this study was comparing the efficacy and adverse effects of sterile water and normal saline as an irrigant fluid in PCNL. Ninety four older than 18 years old patients with renal or upper ureteral stones that were candidate for PCNL randomly allocated in two groups. Patient with American Society of Anesthesiologists (ASA) score 3 and 4 and history of hemolysis excluded from study. From all patient, serum base laboratory and serum electrolyte was taken. Then, under spinal anesthesia PCNL was done with fluoroscope guidance in standard method with use of normal saline in first group. In second group, PCNL with fluoroscope guidance in standard method with use of sterile water was done, too. Preoperative, intraoperative and postoperative variables such as serum sodium, potassium and haptoglobin, cost and duration of surgery, pulmonary and cardiovascular complications compared between two groups. Data was collected and analyzed using chi-square and paired -t tests. Demographic characteristics, operation time, serum electrolytes and volume of irrigation fluid were similar in two groups. Mean postoperative haptoglobin in group one and two were 1.15 ± 0.38 and 1.29 ± 0.53 mg/dl respectively (P = 0.263). Mean cost in group one and two were 117,234 and 25,400 Rial, respectively and there were no cardiovascular and pulmonary complications. Use of sterile water as an irrigation fluid in PCNL is inexpensive, safe and more available and have not more complications in compare with normal saline that can be used as an alternative fluid in PCNL operation.

Background and Self-focused attention is a notable feature of social anxiety. The Self-Regulatory Executive Function (S-REF) model underscores the importance of both working on reducing excessive and uncontrollable self-focused attention. For this purpose, Wells (1990) developed an Attention Training Treatment (ATT) designed to modify dimensions of attention considered to be important in the maintenance of emotional vulnerability. The purpose of the current study was assessing the effect of ATT on anxiety and self-focused attention in socially anxious of adolescences. 184 participants were selected based on their score in Social Anxiety Scale for Adolescents (SAS-A), and Beck Depression Inventory. Then, after a social task, adolescent were asked to complete the Focus of Attention Questionnaire (FAQ). At last, 16 participants with high scores in FAQ were classified into experimental and control groups. Experimental group received 8 sessions of ATT. Two groups answered SAS-A and FAQ after sessions of 4 and 8 and also 1 month follow-up. Experimental group evidenced statistically reductions in social anxiety and self focused attention. The results of this study suggest that anxiety can be lastingly modified through a brief attention manipulation without the use of other cognitive behavioral techniques. Future studies should to explore the mechanisms of change of attention.

Background and Burnout is one of the most important factors in reducing productivity in organizations and involves physical and mental signs, especially in the human service professions. This research was carried out to examine the relationship of occupational burnout and communication skills in nurses in educational therapeutic hospital of Sari, Iran. In this descriptive cross-sectional study, the population included all nurses in educational therapeutic hospital of Sari. Total number was 900. The sample size was 230. They were selected by stratified random sampling. We used three instruments in this study: demographic characteristic questionnaire, Maslach burnout inventory (MBI), and Queendom communication skills inventory. For analyzing the data, descriptive and inferential statistics including one sample size t and Pearson and Spierman correlation coenfficient tests were used. The nurses were moderately high levels of communication skills. Using the MBI subscale, we found moderate levels of emotional exhaustion, low levels of depersonalization and low levels of sense of personal accomplishment. The communication skills had relation with the burnout in personal accomplishment (P < 0.001). We can take improving communication skills in nursing workplaces, in order to reduce the nurse's burnout.

Background and

The presence of phenol and its derivatives in water and wastewater are of major concern because of their toxicity and threat to human life and environment. The aim of this study was determination of the modified lemna minor and azolla in phenol adsorption.

In this emperical-lab study, the washed lemna minor and azolla was used as adsorbents. The effect of vatious parameters on adsorbents performance was investigated. The concentration of phenol was measured by high-performance liquid chromatography (HPLC). Also, data were fitted with variety isotherm and kinetic models.

The phenol adsorption rate increased by increasing of contact time and adsorbent dose in both adsorbents; however, the phenol adsorption per each gram of adsorbents (qe) decreased. The adsorption efficieny increased by decreasing intial phenol concentration. With increasing of solution pH, removal efficiency decreased and optimum pH was 3. Adsorption isotherm data showed that the phenol sorption followed the Langmuir. Kinetics of sorption was well described by pseudo-second order model.

The lemna minor and azolla can be used as effective and low-cost adsorbents to organic compounds removal from industrial effluents. Although due to adventages such as more plenty and higher ability in phenol removal, the azolla is the best adsorbnet.

Background and Lack of awareness of people about the future environmental risks posed by wastes is the most important problem of this sector. Awareness, and then cultural education in this area, can be a breakthrough to this significant environmental problem. This study aimed to assess the degree of awareness of the people of the cities of Gorgan, Gonbad, and Aliabad Katool (Iran) in relation to municipal solid waste management. In this descriptive-periodic study in 2012, a questionnaire with a Cronbach's alpha of 0.78 was used. 550 questionnaires were completed: 200 in different areas of the city of Gorgan, 240 in different areas of the city of Gonbad, and 110 in different areas of the city of Aliabad Katool. Data were analyzed by SPSS software. The awareness of the citizens in the studied cities in the area of waste-related diseases and the waste effect on the environment was satisfactory. The rate of citizen's awareness in the field of recycling and ways of reduction of household waste and the methods of waste disposal was above the average. The awareness in the area of existence of urban recycling organization and its duties was rated weak to average and in the area of compost, it was weak. The performance of citizens in the area of relation of people with urban materials recycling organization and regional municipality regarding solid waste materials was rated very weak to weak and in the area of source waste separation, the performance was rated average. Considering the results obtained, the information of people regarding compost production and existence of urban recycling organization and its duties was low and, it is necessary to provide certain educational programs for increasing public awareness.

The combination of generalized broken livedoreticularis and cerebrovascular accident is referred to as Sneddon syndrome with the incidence of 4/million/year. It predominates among young women and the more prevalent mean age at the moment of diagnosis is the fifth decade. The disease has a slow and progressive clinical course that can lead to disability or death، due to neurological problems or associated complications. Livedo reticularis is characterized by persistent lesions with a cyanotic coloration، which are not influenced by temperature. Patients should be classified as primary Sneddon syndrome، if no etiologic factor can be detected، and secondary Sneddon syndrome، which occurs mainly as part of an autoimmune disorder or in a thrombophilic state. The severity of the disease seems to be correlated with magnetic resonance imaging aspects، but not to the presence of antiphospholipid antibodies. Histopathological study revealed that the disease affects small and medium arteries، located in the profound dermis and superior band of the subcutaneous cellular tissue. We have reported a patient with recurrent vascular accident who had significant skin lesion named livedoreticularis as long as treating for obsessive convulsive for a long time and infertility. We want to emphasis to see well as the first step of examination for diagnosis and treatment of disease.

Candida spp. are ubiquitous yeasts commonly. Those are commensally and opportunist pathogens in humans. Candidiasis in immunocompromised patients and patients with severe underlying diseases or critical illnesses need aggressive diagnosis or treatment procedures. Candida albicans (C. albicans) is the most frequently isolated species. For prevention of nosocomial infections caused by C. albicans، molecular characterization of the isolates is essential to understand the epidemiology of the infections and for tailoring prevention strategies. During the past two decades، different typing methods described for molecular characterization of C. albicans. Multilocus sequence typing (MLST)، as one of these methods، is available for the development of global epidemiological studies. MLST relies on DNA sequence analysis of nucleotide polymorphisms within 7 housekeeping genes with highly discriminating power. For each locus، the different sequences are assigned as distinct alleles، and for each isolate، the alleles at each of the sequenced loci define a sequence type (ST). In this context، global internet-linked databases are now available at www. mlst. net and allow results from strains typed anywhere in the world to be integrated and managed. Analysis of a large number of C. albicans isolates from various hosts and clinical situations carried out with MLST method can provide important insights into the epidemiology of hospital-acquired Candida infections as well as the C. albicans population. With an increased use of this technique، worldwide epidemiological studies will be facilitated and should reveal the patterns of transmission and evolution of C. albicans and help to evaluate the genetic diversity and dynamics of C. albicans population.