مجله دانشگاه علوم پزشکی بابل
سال بیستم شماره 12 (پیاپی 135، آذر 1397)

Lichen planus is a mucocutaneous chronic inflammatory disease with unknown etiology. Malignant potential of oral lichen planus (OLP) and lichenoid reactions (OLR) are controversial. Since micronucleus frequency of cells is representative of risk of malignancy, the aim of present study was to evaluate micronucleus frequency in these lesions. In this cross-sectional study, study group consisted of 20 OLP and 20 OLR which clinically and histopathologically had been confirmed and 20 healthy individuals without oral lesions and systemic disease who presented in oral medicine department of Babol dental college. After receiving written consent, smears were prepared from lesion site at buccal mucosa by cytobrush and were stained at laboratory using Papanicolaou stain. In each slide 500 cells were assessed under light microscope at 400X magnification; mean number of micronucleated cells and mean total numbers of micronuclei were calculated. Mean number of micronucleated cells in OLP, OLR and normal mucosa were 5.20±3.73, 5.65±3.66 and 0.95±1.19 and number of micronuclei were 6.75±4.94, 8±4.66 and 1.30±1.72 respectively. Mean number of micronucleated cells and number of micronuclei were significantly greater in OLP and OLR than normal mucosa (p<0.001) but there were no significant differences between OLP and OLR (p=0.67 and p=0.36 respectively). There were no significant differences in mean number of micronucleated cells between reticular and erosive subtypes of OLP and also OLR (p=0.96). There were also no significant differences in mean number of micronuclei between these subtypes (p=0.96 and p=0.93 respectively). The results of this study indicated that significant increase in micronucleus frequency of OLP and OLR are probably indicative of higher risk of malignancy in these lesions.

Ulcerative colitis is an inflammatory bowel disease and involving colon and rectum. Since patients with ulcerative colitis have high levels of pro-inflammatory and anti-inflammatory cytokines, the aim of this study was to compare the effects of starter bacteria of yogurt and lactobacillus boulagaricus on the activity of peripheral blood mononuclear cells in patients with ulcerative colitis. This experimental-laboratory study was performed on 10 ulcerative colitis patients in Dezful, Andimeshk and Shoosh in two experimental groups and a control group. Experimental groups included co-culture of PBMC and intended bacteria in dilutions of 0.1 and 0.01 and at 48 and 72 hours, and control group including PBMC of the patient at 48 and 72 hours. Variables IL-10 and IL-1β) were measured by ELISA. There was a significant increase in the secretion of IL1β at dilution of 0.1 and 48 hours by PBMC stimulated with bulgaricus 940.4±249.61 in comparison with the starter 669.12±181.11 (p=0.004) and in 72 hours by bulgaricus 796.3±213.34 in comparison with the starter 464.25±128.41 (p=0.000), In dilution of 0.01 and 48 hours by bulgaricus 747.5±198.54 in comparison with starter 529.25±163.82 (p=0.005) and in 72 hours by bulgaricus 617.4±192.5 in comparison with starter 408.62±134.78 (P=0.004). Also, there was a significant increase in the secretion of cytokines in both dilution and both times between of the experimental groups and control. The results of the study showed that Lactobacillus bulgaricus causes inflammation in comparison with the starter by IL1β secretion. Starter bacteria has a better role in reducing inflammation.

Ovarian cancer is the sixth common cancer among women in the world. Preoperative blood cell count can be a biomarker that predicts the severity of different types of cancer and determine the type of surgery. Therefore, the present study was conducted to determine the predictive role of the three blood markers of anemia, leukocytosis and thrombocytosis in the stage and grade of epithelial ovarian cancer before the operation. In this cross-sectional study, the data of 60 patients with epithelial ovarian cancer were evaluated. Demographic data, hemoglobin, white blood cell count and platelets were statistically compared based on the stage of disease and the grade of mass differentiation as good, moderate and undifferentiated. 61.1% of patients with thrombocytosis were in stage 3 and 33.3% of patients with leukocytosis were in stage 2 (p≤0.05), while 20.5% of the patients with anemia were in stage 3 (p>0.05). Moreover, 52.4% of patients with leukocytosis and 61.1% of patients with thrombocytosis had grade 3 tumor (p≤0.05), but only 34.1% of patients with anemia were in this group (p>0.05). Based on the evaluation of the ROC curve, cut-off point of the white blood cell was calculated to be 9050/ml with a sensitivity of 64% and specificity of 65% and platelet count was calculated to be 266000/ml with a sensitivity of 88% and specificity of 53%. Based on the results of this study, preoperative leukocytosis and thrombocytosis were correlated with stage and grade of epithelial ovarian cancer and had a predictive role.

Gastric cancer is one of the most common malignancies in the world, which is classified as a multifactorial illness. Most canceric patients experience a period of stress. Since being patient and positive thinking play an effective role in coping with chronic diseases. Therefore, this study was conducted to evaluate the efficacy of cognitive-behavioral therapy group on being patient and positive thinking in gastric cancer patients. This cross-sectional study was performed on 92 men with gastric cancer who were referred to the Tooba Medical Center in Sari who were randomly divided into two groups of 46 test and control groups. The two groups completed the standard questionnaire of positive thinking (150-30 points) and being patient (100-0 score) in the pre-test phase. The test group was trained of cognitive behavioral therapy for ten sessions of 90 minutes. The control group did not receive any special intervention. Then, both groups completed the questionnaires again in the post-test phase. The mean score of positive thinking before the test in the test group was (88.71±24.21) and in the control group was (94.54±24.23). The mean score of being patient in the test group was (26.66±22.20) and in the control group was (30.45±22.42) that they were not significant. However, in the post-test phase, positive thinking (test group 106.33±28.16 vs. control group 94.43±24.71) (p<0.01) and in terms of being patient (the test group 23±23.5) /40 versus 30.91 ± 20.89 control group (p<0.01) had a significant difference. According to the results, -behavioral therapy group can increase being patient and positive thinking in patients with gastric cancer.

Thyrotoxicosis is a disease that results in excessive thyroid hormone activity in the blood. Common causes include Graves's disease, toxic nodular goiter (single or multiple) and thyroiditis. However, the cause of thyrotoxicosis may be different due to geographical areas, so in this study, the prevalence of thyrotoxicosis in the Babol County was investigated. In this cross-sectional study, 30 thyrotoxic patients who were referred for thyroid scan were evaluated. The thyroid scan was performed with radiopharmaceutical of technetium pertechnetate and based on the results of the scan; the patients were divided into two general groups. The first group increased the absorption of radiopharmaceutical or hyperthyroidism, which included graves and, toxic nodular goitre (single or multiple). The second group reduced the absorption of radiopharmaceutical, which included thyroiditis (subacute and painless). Of the 300 patients with thyrotoxicosis, 209 patients were women (69.7%) and 91 patients were men (30.3%). In thyroid scan, 135 cases of thyroiditis (45%), which 95 cases were women (70.4%) and 40 cases were men (29.6%), 96 patients of Graves (32%), 57 cases were women (4 (59%) and 39 cases were men (40.6%) and 69 cases of adenoma (23%), 57 cases were women (82.6%) and 12 cases were men (17.4%). Thyroiditis in our region may be more frequent than Graves' disease and can be the most common cause of thyrotoxicosis, which can be important in medical decision-making.

Maple syrup urine disease is a rare inborn metabolic inherited disorder caused by deficiency of branched chain α-keto acid dehydrogenase complex and leading to accumulation of branched chain amino acids in body fluid. The incidence of MSUD is higher in populations with high consanguineous marriage. BCKD is a mitochondrial complex which is encoded by four nuclear genes (BCKDHA, BCKDHB, DBT, and DLD) and MSUD can be caused by mutation within any of these four genes. Accumulation of metabolic is associated with impairment of energy metabolism, provoke apoptosis, dysfunctional neurotransmitter synthesis and neuropathological defects such as seizure, psychomotor delay and coma. In the present study, we investigated the incidence of MSUD in Iran, compiled previously reported mutations in Iranian population and also explained molecular pathomechanisms underlying MSUD. To compile MSUD mutations, we systematically reviewed PubMed and magiran databases to find related articles in English and Persian language, respectively. The key words "MSUD" and "Iran" was used as query. Until 9th December 2018, twenty four MSUD mutations were collected from Iranian population of which 18 mutations have been only identified in Iran and were not reported in other populations yet. Likewise, because of high consanguineous marriages, the incidence of MSUD were higher than worldwide average in different provinces. Identification and compiling of MSUD mutations in Iranian population can be useful for prenatal genetic diagnosis in at risk families and play crucial role in early diagnosis and also treatment before starting neurological symptoms in newborns.

Congenital anomalies are the main causes of neonatal mortality and morbidity. We performed this systematic review study to investigate the association between mothers’ exposure to air pollution during pregnancy by combining for a variety of air pollutants and anomaly defect outcomes. The databases of PubMed, Scopus, Cochrane, Google Scholar, SID, IranMedex and Magiran until May 2018 and reference section of relevant articles, were searched to identify both English and Persian studies on Ambient Air Pollution and Congenital Anomalies. A total of 28 articles from 245 articles were lastly included. The results of studies showed significant association between first trimester exposures to Carbon monoxide (CO), Particulate matter <10 microns (PM10), PM2.5, Ozone (O3), sulfur dioxide( SO2), nitrogen oxide (NO2) and increased risk of specific congenital heart defects , particularly ventricular septal defect (VSD) , tetralogy of fallot (TF), atrial septal defects (ASD), and patent ductus arteriosus (PDA). Also, SO2, NO2, CO and PM10 were significantly associated with cleft palate (CP) with or without cleft palate (CL ± CP) . Some studies show that Air Pollution exposure was associated with neural tube defects, Omphalocele, and Urogenital defects. We found some evidence for an effect of ambient air pollutants on congenital anomalies such as congenital heart defects and cleft palate with or without cleft, but confirmation of these associations will be needed in future studies.

Cancer is one of the major health problems in the world and chemotherapy is still the most common solution for its treatment. A great deal of studies in this area have been devoted to evaluating the occurrence of apoptosis as a key factor in preventing cell's escape from cell cycle regulation mechanisms. The aim of this study is to summarize the studies on metabolism, messenger pathways and effective pharmaceutical factors on sphingolipids involved in apoptosis. In this review article, the national and international databases of PubMed, Scopus, Google Scholar, Web of Science, ISC and Magiran were searched for the keywords “apoptosis”, “sphingolipids”, “ceramide”, “sphingosine” and “cancer” without time limit and the related material was collected. Among the apoptotic messenger molecules, the key role of the sphingosine and ceramide has been considered as the cornerstone of sphingolipids in many of its controlling processes. It has been shown that ceramide is a key regulator in apoptosis, and increase in its cytoplasmic levels increase the proliferation of cascades resulting in programmed cell death. The bio-production and bio-destruction of ceramide is accomplished by the activity of several enzymes, and much evidence suggests the effect of external factors on enzyme systems. In contrast, the phosphorylated form of sphingosine is an important index for guiding cells toward proliferation and differentiation. It has been found that several commonly used chemotherapy drugs and compounds that are being studied in the treatment of cancer affect at least one of the enzymes of sphingolipids metabolism. Sphingolipids and the enzymes involved in their metabolism are introduced as new pharmacological targets for the induction of apoptosis, and it is obvious that analyzing the effective therapeutic factors and the ways of controlling them would be helpful in finding anticancer drugs.

Considering that the experience of nurses in pain management in patients in the emergency department is a reflection of their feelings, thoughts and attitudes in this regard, identification of their experiences can be the basis for dealing with the challenges. The present study was conducted to explain the experiences of nurses regarding pain management in patients referred to the emergency department. In this qualitative study, 14 nurses working in emergency departments of hospitals affiliated to the Tehran University of Medical Sciences participated through purposive sampling. The data were collected through individual, in-depth and semi-structured interviews and were simultaneously analyzed by conventional content analysis after transcribing the interviews. Based on the data analysis, two themes of "challenges and barriers to pain management" and "right to patient-centered pain relief" were extracted. The results indicate the existence of challenges such as limited authority, inefficient supervision, and etc. in organizational‐professional areas such as fear about side effects, negligence, and etc. in the domain of human factors. Pain relief was also found as a fundamental right that requires patient-centered care. Based on the results of this study, despite the numerous challenges in pain management in the emergency department, patient relief is one of the care priorities and fundamental human rights. Therefore, emphasis on the fundamental values of nursing profession and paying attention to patients' individual needs and rights can be effective in managing the pain properly.

Mucopolysaccharidosis type VI (MPS VI) is a lysosomal storage disorder and autosomal recessive caused by arylsulfatase B deficiency in the body and progressive accumulation of glycosaminoglycan in different organs. Considering that this disease has low prevalence in Iran and worldwide, we report a case of MPS VI diagnosis in this study.  A five-year-old boy was referred to Imam Khomeini Clinic in Esfarayen due to impaired growth and dyspnea. In the biography of this boy, there is the history of previous hospitalization due to dyspnea when he was three months, two years and three years old and was treated with antibiotics and salbutamol spray for three days each time. The pediatrician got suspicious of MPS because of the child's peculiar face. Blood tests were performed in terms of the levels of lysosomal enzymes and the urine sample was sent to the Metabolic Laboratory of Hamburg University Medical Center to study the glycosaminoglycan levels. After six months, the results of the tests indicated low levels of serum arylsulfatase B and the increase in chondroitin and urinary levels of dermatan sulfate. To investigate the presence of complications, echocardiography, electromyography, eye and ear examinations as well as radiography for chest, back, hip and hand were performed. Clinical and paraclinical findings confirmed the MPS VI disease and therefore, treatment with naglazyme enzyme was started for the patient. Based on the results of this case report, growth impairment, history of hospitalization due to respiratory problems and the patient’s peculiar face are key points for further investigation regarding MPS VI disease.