مجله دانشگاه علوم پزشکی بابل
سال شانزدهم شماره 12 (پیاپی 87، آذر 1393)

Vitamin D deficiency is an important known responsible factor for development,progression and exacerbation of many musculoskeletal disease.The aim of the present study was to determine the status of serum vitamin D in a number of common musculoskeletal conditions presented an outpatient rheumatology clinic. Pateints with musculoskeletal presentations having symptoms for at least three months entered the study.Serum vitamin D was determined by assessment of serum 25-hydroxyvitamin D (25-OHD) using ELISA method, and levels less than 20 ng/ml was considered as deficiency. The primary objective of this study was to compare serum 25-OHD level and frequency of 25-OHD deficiency between patients with musculoskeletal symptoms and controls. The secondary objective was to determine the relationship between serum 25-OHD deficiency and musculoskeletal conditions with respect to age and sex. 1099 patients (910 females) including 291 (26.47%) patients with knee OA,192 (17.47%) with rheumatoid arthritis (RA), 76 (6.9%) with non-rheumatoid arthritis inflammatory arthritis (NRAIA), 237 (21.56%) patients with nonspecific skeletal pain, 163(14.83%) patients with low back pain (LBP), 114(10.37%) patients with arthralgia,and 26(2.36%) patients with inflammatory back pain (IBP) entered the study to compare with 374 (243 females) controls. Serum 25-OHD levels and frequency of 25-OHD deficiency in knee OA, RA, NRAIA, IBP did not differ significantly with the control group, but in patients with nonspecific musculoskeletal pain and low back pain serum 25-OHD levels were significantly lower than controls. Serum 25-OHD deficiency increased the risk of nonspecific skeletal pain, LBP by 3.9 and 3.32 times respectively (p=0.001 for both). The association was greater in women as compared with men.In patients aged less than 55 years, 25-OHD deficiency increased the risk of knee OA 1.71 times (p=0.014) and the risk of arthralgia 1.84 times (p=0.018). Vitamin D deficiency is significantly related with a number of common musculoskeletal conditions like nonspecific skeletal pain, LBP, arthralgia, according to age and sex. This issue requires further prospective, in particular placebo-controlled studies, to determine efficacy of supplemental vitamin D on skeletal symptoms by comparison of symptoms before and after supplementation.

Feeding intolerance is a common phenomenon in the NICU. Nursing care is a key factor in increasing the survival, health and development of premature infants. The aim of the study was to determine the effect of Kangaroo mother care on feeding tolerance in preterm infants. This cross over clinical trial study was performed on 100 (28-32 weeks) infants in Al-Zahra Teaching and 29 Bahman Hospitals in 2012. The infants were randomly selected and divided into two groups. The infants of first group were placed in the position of kangaroo mother care and supine position at twice of first gavage and subsequent gavage, respectively. The infants of second group were placed vice versa at twice of first and second gavage. Then the gastric residual volume was measured one and two hour/s after each feeding and three measures of abdominal distention, vomiting and defecation were examined and compared in both groups. (IRCT: 201209254613N9) Statistically, there was no significant difference between two groups in terms of demographic variables, weight, gestational age, the volume of gavaged milk, chronological age. Percentage of gavage residual volume average in the first position of kangaroo mother care (10/86±9/26) was lower than the supine position (28/55±21/39) (p≤0/001) and the number of babies who had ≥25% gavage residual volume in the supine position were larger than kangaroo mother care position. The results showed that the kangaroo mother care position was effective on the feeding tolerance of preterm infants. If the infants are in kangaroo mother care position, they can benefit from not only the kangaroo mother care but also the positive impact on the functioning of the digestive system.

Limited resources for adult stem cells necessitate appropriate methods for isolation, proliferation and differentiation of these cells. Human third molar is an easily available source in this regard that usually remains unused. The aim of this study was to investigate the isolation, culture and odontogenic differentiation of human dental pulp stem cells. In this experimental study, twenty human third molars were used for stem cell isolation. The digested pulp tissue culture approach was used to isolate stem cells. Some markers of stem cells were studied by RT-PCR. Stem cells were then induced towards odontoblast cells by use of BMP-2 and Dexamethasone. Expression of odontoblastic markers was investigated in induced cells by RT-PCR and immunocytochemistry methods. The human dental pulp stem cells were isolated with high efficiency. RT-PCR analysis showed that these cells express some markers of embryonic stem cells. However, the induced cells did not expressed odontoblastic markers such as DSPP, DMP-1, BMP7 and Osteopontin. Also the induced cells did not produce DSPP and DMP-1 proteins. Despite the successful isolation of stem cells, the induced cells failed to differentiate into odontoblasts. This may be due to the differentiation method as well as the passage during induction or monolayer culture.

Acute lymphoblastic leukemia (ALL=Acule Lymphoblastic Leukemia) is the most common type of hematological malignancies in Iranian children. Pterostilbene (PT) is a natural stilbenoid in blueberries. Since the effect of PT on lymphoblastic leukemia cell line has not been investigated, the aim of the present study was to evaluate the effects of PT induction and cellular proliferation inhibition on this cell line. In this experimental study, Jurkat cell line was cultured in standard conditions with different concentrations of PT (0, 30, 40, 50, 60, 80 and 100 µm) for 24, 48 and 72 hours and compared with the cell of control group. Then, the effect of PT on cell viability and induction of apoptosis was measured using MTS assay and Annexin V-FITC kit. Inhibition of cellular proliferation was 44%, 47% and 57% at 60 µm concentration and 71%, 78% and 89% at 100 µm concentration after 24, 48 and 72 hours of PT incubation, respectively (p<0.05). Cell apoptosis was 60% at 80 µm, 50% at 60 µm and 27% at 40 µm compared to 4.63% in control. There was significant difference at 80 µm concentration. The results demonstrated that the PT was effective on the proliferation inhibition and induction of apoptosis in Jurkat lymphoblastic leukemia cell line. The study of the mechanism of apoptosis induction by using this combination can be a progressive step into target therapy.

Since C.spinosa and M.alba traditionally have been used to treat some diseases, this study investigated the anti-diabetic and anti-hyperlipidemic effects of hydroalcoholic C.spinosa seeds and M.alba aqueous leaves xtract separately and in combined on blood glucose and lipids in diabetic. In this experimental study, 60 rats weighting 200-220 gr were divided into 6 groups of 10 each: diabetic control group, treated diabetic groups with different concentrations of 200, 400 and 800 mg/kgbw with the extracts of these two plants separately and in combination and treated diabetic group with Glibenclamide. Streptozotocin was used to induce diabetes. The extracts of C.spinosa and M.alba with doses of 200, 400 and 800 mg/kgbw and glibenclamide with 600 doses were fed them separately and in combination. Taking blood from rats was done in fasting condition and blood glucose level was determined with enzym and triglyceride, cholesterol and lipoproteins method using Pars Azmon Kits. The extract of M.alba leaves had the best effect on reducing the blood glucose level with dose of 200mg/kg (92/26±16mg/dl) (p<0/01). 800 mg/kg concentration reduced cholesterol (74/8±16mg/dl), triglyceride (25/7±12 mg/dl) and LDL (10/2±1/5 mg/dl) (p<0/05). 400 mg/kg dose of M.alba extract increased the amount of HDL (63/2±2/5mg/dl, p<0/05). The extract of C.spinosa with 200 mg/kg concentration had the best effect on reducing the blood glucose (117/1±16 mg/dl, p<0/01) and triglyceride (82/02±14/2 mg/dl, p<0/05) levels. This extract with 800mg/kg concentration declined cholesterol (83/3±1mg/dl) and LDL (9/7±2/1mg/dl) (p<0/05). Its concentration of 400mg/kg increased the amount of HDL (74/8±19/7). The combination of two extracts with dose of 200 mg/kg reduced blood glucose (106/4±24) and triglyceride (73/23±18mg/dl) (p<0/05). 800 mg/kg of this combination reduced cholesterol (69/4±2/4mg/dl) and LDL (14/4±3/9 mg/dl) (p<0/05). 400 mg/kg of it increased HDL (60/5±17mg/dl, p<0/01). The results showed that there are some effective materials in C.spinosa and M.alba extracts which have the capability of reducing blood glucose and lipids.

Dentistry students are exposed to environmental stresses in addition to educational stresses. The continuous stress can lead to the complications such as physical, mental and emotional injuries. Strengthening the physical, mental and social resources can improve the performance and health of students against stress. The aim of this study was to evaluate the stress level and identify the stressors in faculty of dentistry in medical sciences of Babol. This cross-sectional study was done in academic year of 2013-2014 on dentistry students who entered the Dentistry Faculty of Babol from 2008. In this research, two questionnaires were concurrently used. The first questionnaire was DASS21 and the second one was derived from the research of Mashhad Dentistry Faculty to investigate the factors that generate the stress. Questionnaires were analyzed based on the variables of gender, age and entrance year. 217 students included 96 male (44.2%) and 121 female (55.8%) completed the questionnaires. 74.2% of students who were in fourth grade had abnormal stress. In addition, there was no significant difference in the stress mean of two genders. Role of the academic stressors such as failing in final exam, embarrassing to injure the patients and to catch the infectious diseases significantly was higher than the non-academic stress factors on the stress level of students. The results showed that the dentistry students had high levels of stress and most of them were related to academic factors.

Although opioid drugs cause analgesia and more effective in treatment of pain but, its utility is hindered by the development of tolerance to its analgesic effects. Orexin A and B (hypocretin 1 and 2) discovered in 1998 and projected to large areas of the brain regions involved in the tolerance and dependence to morphine. The attenuated withdrawal syndrome seen in orexinknock-out mice suggests that such regulation of orexin neurons may be an important contributor to morphine physical dependence and to the expression of withdrawal. This systematic review conducted on articles published on orexin from 1998 to 2012 in the following electronic databases: Medline, Pubmed, ISI and Scopus by using keywords including morphine, orexin, tolerance and dependence. Although morphine-tolerance tended to develop in response to repeated injections of morphine, pre-treatment of OXR1 antagonist prevented this effect, causing a delay in the development of morphine-tolerance. Moreover, co-administration of orexin receptor 1 antagonist with morphine significantly decreased the somatic signs of withdrawal.This suggested development of orexin receptor antagonists could prevent the development of tolerance and dependence to morphine.

Hematuria is blood in the urine and one of the most common disorders of the urinary tract, which is characterized by its simplicity. Hematuria in adults should be considered as a sign of urologic malignancy until proven otherwise.In this study, 28 articles in English and 7 articles in Persian were reviewed. Persian articles with Key words including hematuria, infection and trauma were surveyed in Iranmedex and Magiran(1991- 2012) and English articles with key words including kidney injuries, hematuria and bladder cancer were surveyed in PubMed, Scopus and Sciencedirect(1990-2012).Also the books: Nelson, Campbell, Surgery(Oxford), Urologic Trauma were used.Hematuria is indicative bleeding in urinary tract. Bleeding may be occurred suddenly or frequently. Incidence of urological cancer in patients with Frank hematuria reported between 18.9% - 24.2% that usually are seen in bladder and kidney tumors. In 85-90% patients with bladder cancer, first sign is hematuria with no sign or pain. Urinary tract infection (UTI) is the most common bacterial infection. Urinary tract infections are common in older men and women who are associated in some cases with hematuria. According to statistics, injuries in genitourinary system are seen almost in 10% of patients who referred to emergency centers because of trauma.The causes of hematuria from benign causes such as infections to serious causes such as kidney disease or cancer are different.

It has been emphasized on sanctity of human life and the inherent dignity and sanctity of killing men in all the Abraham religions. In revelation teachings of Islam, murder is considered one of the greatest sins andnobody has right to take his/her own life or the other life. Progress in medical sciences, care facilities for patients,organ transplantation by skilled specialists and surgeons,and recognizing patient's consciousness level caused keeping patients with brain deathto be considered as a today issue in medical world. In this study the phenomenon of brain death in jurisprudence and law scale was surveyed. The viewpoint and sentences of jurisprudents, contemporary Shia scholars and jurists about brain death was surveyed. There are a lot of verses in Quran and narratives about the right of life and death. Researching for such verses and narratives is a way to achieve a reasonable result. The death is separation of soul from the body. Cardiac arrest solely is not enough to accept the death. Finishing the life of a person with brain death is deemed as an instance of manslaughter. The brain death solely is not enough for amputation and is not allowed. Removing the organs of a brain dead patient before his/her real death and after his/her death is not permitted. It is not permitted to remove the device from a brain dead patient who is alive with it and a person who does it considered as a killer.Permission of brain dead patient for donation of organcannot also cause the sanctity sentence to be waived. Results of this study showedthat from the jurisprudential viewpoint, the agents who ceasing the services and the persons who amputate brain dead patient's organ and caused the absolute death of the patient committed the unlawful act and are liable for incurred loss. In case of the permission of patient or next of kin to donor the organs, the right of retribution and blood money are waived, otherwise the right of retribution and blood money is reserved for next of kin.

Oral lichen planus (OLP) is an inflammatory mucocutaneous disease which is common in adults. OLP occurred in children rarely. The aim of this study was to introduce a 13-year-old girl with OLP and her treatment and follow up.CASE: The 13-year-old patient was admitted with the complaint of erythema of the buccal mucosa and clinical diagnosis was reticular and erosive LP. The patient had no cutaneous signs. After the histopathologic confirmation of LP diagnosis, the patient's condition was controlled with oral health maintenance and corticosteroid therapy and wasn’t relapsed after 3 month follow up. The results showed that the pediatric dentists should know the clinical manifestations, diagnosis and treatment of OLP in children and should periodically monitor the patients to control the disease recurrence and possible malignant changes.