مجله دانشگاه علوم پزشکی بابل
سال نوزدهم شماره 6 (پیاپی 117، خرداد 1396)

Corticosteroid therapy is one of the main treatments for asthma and considering the effects of corticosteroid on bone mineral density, the present study was conducted to analyze the bone mineral density in children with asthma treated with inhaled corticosteroids.
This cross-sectional study was conducted among 62 children 6 to 14 years old with moderate or severe asthma admitted to Amirkola Children's Hospital, whose disease have lasted for at least one year and were treated with inhaled corticosteroids. DEXA method was used to measure bone density using Hologic QDR4500 device. Based on this method, the lumbar spine and the femur neck was examined and Z-Score criteria was recorded for each patients. In addition to the above-mentioned information, the dosage, duration of consumption and duration of the disease was also recorded for each patients.
FINDINGS: The mean age of children was 7.8 ± 2.1, among which 33 children (53.2%) were boys. The mean duration of asthma was 2.3 years and the mean forced expiratory volume in 1 second (FEV1) was 77.3±5.4% in patients. Osteopenia was observed in 5 patients (CI-95%=1–15, 8.1%). There was no significant difference between osteopenia and gender, duration of consumption and age. However, there was a significant difference between osteopenia and the dosage of the drug (p=0.007).
Osteopenia was observed in a considerable percentage of children with asthma who were treated with fluticasone spray for more than one year, which was also affected by drug dosage.

Enterotoxigenic Escherichia coli (ETEC) is the most common causes of diarrhea and its mortality is estimated at 157,000 deaths per year that equivalent 9 percent of all deaths attributed to diarrhea. Vaccine development against ETEC has been identified as an important primary prevention strategy against bacteria. Present study aims to provide importance of and pathogenesis of ETEC bacteria and research in the field of vaccine against it.
In this study literature search was conducted in NCBI databases with ETEC, virulence factors, colonization factors, enterotoxins and vaccine as keywords. Related articles were collected and investigated.
FINDINGS: Survey of articles indicated that mucosal immunization could provide the secretary IgA antibody (sIgA) response and are of particular importance for protection against ETEC infection. Diversity and geographical distribution of bacterial strains is one of the main problems to deal effectively against disease caused by ETEC. One of the important points is expressing of different CFs on bacterial surface. Development of a vaccine against bacteria and toxins strains is dependent on careful investigation of the prevalence of colonization factors and toxin strains.
Scrutiny could reduce information gaps and expected to help appropriately for development strategies against bacteria. Design multivalent ETEC immunogens containing the most prevalent colonization factors and toxins may provide protection against a wide range of ETEC strains.

The birth of a premature infant is associated with long – term hospitalization and separation from family. Hospitalization of the infant affects the attachment between the infant and mother and affects the quality of care given to the infant by mother and increases the risk of delayed behavioral problems. Therefore, the present study aims to analyze the effect of family-centered care program on maternal attachment in mothers of premature infants.
In this clinical trial, 60 mothers of premature infants with gestational age of 30 to 36 weeks, hospitalized in neonatal intensive care unit of Motahari Hospital were selected using convenient non-probability sampling and were randomly divided into two groups of control and intervention (30 mothers in each group). The family-centered care program was performed on intervention group in three steps: In the beginning of infant care, before the fourth day of hospitalization and before discharge, while the control group was only under the usual care. The level of maternal attachment was measured using Avant's mother-infant attachment behavior questionnaire and each dimension of attachment behavior was scored from 0 to maximum based on care (45), proximity (45) and emotional (37) behavior (IRCT: 2017021914454N3)
FINDINGS: The total score of maternal attachment increased from 34.3±5.1 to 61.6±4.5 in intervention group and increased from 33.1±4.2 to 37.8±3.7 in control group. There is a significant difference between the two groups in terms of total score of attachment between mother and premature infant (p Results of the study demonstrated that implementation of family-centered care program increases the attachment between mother and infant more than common infant-care methods.

Neonatal pain causes changes in the structure and function of brain in addition to acute physiologic symptoms and is followed by delayed development of infants. This study aims to determine the implementation of pain management and assessment in neonatal intensive care units.
This cross-sectional study was conducted among 138 nurses working in neonatal intensive care units through census. The data were collected using researcher – made questionnaire including two parts: pain management and assessment and demographic information. The minimum and maximum scores were 0 and 552, respectively, shown in the form of percentage.
FINDINGS: At a response rate of 80.23%, the mean age of participants was 31.76±5.41 years and the mean experience of nurses working in a neonatal intensive care unit was 4.36 ± 3.58 years. The cases of implementation of pain management and assessment were as follows: care management for pain reduction (72.8%), allow parents to relieve pain (68.5%), swaddling (66.7%), pain assessment while implementing therapeutic and caring measures (62.9%), the use of sucrose solution (61.6%), teaching parents about observing pain symptoms in the infant’s face (58.7%), recording infant’s pain behaviors and the method for relieving the pain (52.4%), pain assessment at least every 4 hours (52.2%) and the use of valid tools for pain assessment (36.8%).
According to the results of this study, pain management and assessment was implemented in more than half of the cases.

Helicobacter pylori is a spiral shaped and gram negative bacterium which causes peptic ulcer and has an important role in gastric carcinoma. Different components of urease are the important factor to stimulate the immune system. There is no effective vaccine against this bacteria and research on finding an effective vaccine is necessary. The aim of present study was to produce ureI gene construct and evaluation of the expression of this gene.
In this experimental study, the amplification of ureI gene was performed using PCR on standard strains of H. pylori genome that obtained from Pasteur institute. 612 bp fragment of ureI gene was cloned by T/A cloning technique into pTZ plasmid, and sub-cloning was done in PIRES2-EGFP vector. PIRES2-EGFP-ureI recombinant vector was transformed using electroporation into CHO cells and ureI gene expression was evaluated by RT-PCR.
FINDINGS: Cloning of 612 bp fragment for ureI gene in pTZ and PIRES2-EGFP vectors had confirmed using PCR, digestion by SacI/EcoRI restriction enzymes and sequencing. After the RT-PCR on transformed CHO cells, the ureI gene fragment was observed.
The PIRES2-EGFP-ureI recombinant vector can express the ureI gene. The successful gene expression of this target gene in animal cells can be used to evaluate the immunogenicity as a vaccine in laboratory animals. Also, this generated recombinant vector has the potential for assay as DNA vaccine in future experiments.

Phenylketonuria (PKU) is the most prevalent inborn error of amino acid metabolism in the world and its incidence rate is increasing in Iran. The aim of the present study was to assess the efficiency of HRM technique as a fast and suitable method in identifying common mutations of phenylalanine hydroxylase gene including IVS10-11G>A and P281L in order to improve the early detection of the disease to prevent the occurrence of it.
In this case-control study, 20 DNA samples including one sample with IVS10-11G>A mutation , one sample with P281L mutation and 18 control samples were extracted from peripheral blood collected in Medical Genetic Center of Isfahan and were genotyped with HRM technique. To validate the mutations, the mutant samples were genotyped using sequencing. Bioinformatic analyses were used for determining structural and functional effects of P281L mutation on the of PAH protein.
FINDINGS: HRM analysis identified IVS10-11G>A and P281L mutations with a sensitivity and specificity of 100% and the mutant and normal samples differentiated well in normalized and difference plots. Bioinformatic analyses demonstrated instability and pathological effects of PAH protein containing P281L mutation.
HRM is a simple and fast technique detecting the two IVS10-11G>A and P281L mutations with 100% sensitivity and specificity.

Giardiasis is one of the most common infections of the gastric tract in the world, which is caused by protozoa. Today, metronidazole, furazolidun, tinidazole and quinacrine are commonly used to treat this disease. These medications are associated with several adverse side effects and finding an alternative solution with fewer side effects seems necessary. The present study aims to analyze the effect of hydroalcoholic extract of rosemary (Rosmarinus officinalis) on the cysts of Giardia lamblia parasite under in vitro conditions.
In this experimental study, 25 mice were categorized into 5 groups (n=5) including negative control group, positive control group (treated with metronidazole) and other three treatment groups (treated with 100, 200 and 400 mg/ml rosemary extract). Then, the effect of hydroalcoholic extract of rosemary was analyzed until the tenth day.
FINDINGS: According to the results of this study, the body weight of the mice in the groups treated with hydroalcoholic extract of rosemary (20.78 - 26.64) was less than control group (28.70 ± 0.69), which received no medication (p Results of the present study demonstrated that rosemary has proper in vivo effects and can be considered as a suitable alternative for treatment of Giardiasis.

Considering the increasing number of patients with cancer and the relative ineffectiveness of existing treatments, finding a modern technique for cancer treatment has been one of the major topics of research in recent decades. The present study aims to load curcumin anticancer drug on targeted iron oxide nanoparticles.
In this laboratory research, iron oxide nanoparticles were synthesized using polyol method. Then, they were coated with polyglycerol as a polymeric coating through ring – opening polymerization method. Folic acid (with three weight ratios of 2, 25 and 50%) was used to target the system constructed for specific penetration into the cancer cells. The experiments of loading the drug were performed with three weight ratios of 0.5, 1 and 2 µg nanoparticles on coated and targeted nanoparticles. Then, drug release rate was measured under in vitro conditions. Finally, MTT Assay was used to analyze cell toxicity of the loaded drug.
FINDINGS: Results indicated successful construction of 20 nm nanoparticles. The maximum rate of drug loading into the system was about 88 and 82% for non-targeted nanoparticles and targeted nanoparticles, respectively, while increased targeting had adverse effects on drug loading. Moreover, the loaded drug had a more successful therapeutic effect compared with the free drug.
Results of the study demonstrated that the constructed nanoparticles have the necessary efficiency to act as a system for transferring anticancer drug.

Central nervous system (CNS) tuberculosis (TB) is one of the extrapulmonary manifestations of mycobacterium tuberculosis. Cerebrovascular accidents and cerebral abscesses in children constitute 5 to 18.7% of all cases. Therefore, a child with congenital heart disease (Tetralogy of Fallot) and neurological manifestations consistent with brain abscess and suffered from CNS tuberculosis.
CASE PEPORT: The patients is a 10-year-old boy with Tetralogy of Fallot who underwent ceftriaxone, vancomycin and anticonvulsant treatments with initial suspicion of central nervous system infection and with symptoms of fever, seizures and decreased consciousness. Due to observation of cerebral edema and several lesions in brain parenchyma in CT scans in the form of abscess, corticosteroid and metronidazole was added to the treatment process and the patient underwent cerebrospinal fluid analysis. Considering low sugar of cerebrospinal fluid, improved brain image and at the same time, lack of clinical recovery, we suspected mycobacterium tuberculosis. Therefore, the cerebrospinal fluid PCR was sent and the experimental anti-tuberculosis treatment started. Finally, the result was positive in terms of mycobacterium and anti-tuberculosis treatment continued.
Tuberculosis as the cause of disease manifestations in endemic areas should always be taken into consideration. To justify patient symptoms with more common causes, one should not discard other diagnoses; because early diagnosis of CNS tuberculosis prevents certain death.