مجله دانشگاه علوم پزشکی مازندران
پیاپی 157 (بهمن 1396)

Background and Different genera of enterobacteriaceae have important roles in gastrointestinal diseases such as diarrhea. Among these, Enterotoxigenic E. coli (ETEC), enterohemorrhagic E. coli (EHEC), and Shigella are three main bacteria which are transmitted via contaminated food and water. Vaccination is a good strategy to combat these pathogens. In the present study, a chimeric antigen, containing the main antigens of these three bacteria was designed, expressed in E. coli host, and tested for protection against EHEC strain.
Specific primers were designed to fuse these antigens. The properties of the chimeric antigen, including physical and chemical properties, secondary and tertiary structures, and B cell and T cell epitopes were obtained via in silico analysis. After the fusion of the genes, the resulting recombinant pET28a() vector was transferred into the competent E. coli cells. Expression was induced and the protein was purified. Then, the animals were immunized through subcutaneous administration of the antigen. Finally, the immunized animals were challenged by live E. coli O157:H7 cells.
In silico analysis showed that the chimeric antigen had appropriate physical and chemical properties which could be expressed in various expression systems. In addition, the antigen has potent B- and T-cell epitopes. Experimental results showed that the antigen has efficiently provoked the mice's humoral immune system. Challenging the immunized mice by live bacterial cells showed that the chimeric antigen was able to protect the mice against E. coli O157:H7 strain.
Both in silico analysis and experimental results showed that the chimeric antigen has appropriate properties which can be considered as a proper candidate vaccine against the three bacteria mentioned.

Background and Spinal cord injury (SCI) is one of the most disabling diseases with various physical and psychological consequences. One of the treatments of SCI is using agents that have neuroprotective effects such as Vitamin C and ubiquinone. This research aimed at investigating the effect of co-administration of these agents on rat experimental model of SCI.
Adult male Wistar rats (n=40) were divided into sham, lesion, AA, CO10, and AAࣤ groups. In sham group only laminectomy was performed and in other groups contusion model of SCI was done. After 24 hr, the animals in AA, COQ10, and AAࣤ groups received intraperitoneal injection of AA, COQ10 and AAࣤ, respectively. Then, behavioral assessment and biochemical study were performed. Eight weeks after treatment, the brains were removed and 5µ sections were prepared. Finally, cresyl violet staining was done.
There was a significant difference in BBB score of AA, COQ10 groups compared to that of the AAࣤ group (P Co-administration of AA and COQ10 in contusion model of SCI led to functional recovery, reduction of MDA, increase of GR level in serum and increase of motor neurons survival in anterior spinal horn.

Background and Cerium oxide nanoparticles (CNPs) are widely used as a catalyst in industry and as an antioxidant in applied nanomedicine. The biological effect of CNPs exposure on testis tissue is not known. The objective of this study was to evaluate the effect of CNPs on testis in mice model.
In this experimental study, CNPs were administered intraperitoneally at 5 mg/kg dose for 7 consecutive days. Testicular toxicity was evaluated by histopathological, biochemical, and immunohistochemical assays.
According to the findings CNPs significantly induced oxidative stress in testis (P Such observations suggest that CNPs at 5 mg/kg dose with pro-oxidative stress effect can lead to testicular toxicity. Also, this study confirmed that CNPs could pass through the blood-testis barrier.

Background and Herbal medicine have always been used in Iran and other countries around the world. They have different effects on human body, some are beneficial and others could be detrimental. There are few studies that investigated the effect of turmeric (Curcuma Longa) on female reproduction. This study examined the effect of turmeric extract on in vitro maturation of mice’s primordial oocytes and on the number of embryos resulting from fertilization.
The NRMI mice were divided into four groups: experimental group 1 and 2, sham, and control. The control group received normal food and water for 7 days; the sham group was daily gavaged with 0.002 mg/kg body weight of distilled water and alcohol for 7 days. The experimental groups 1 and 2 received 0.001 and 0.002 mg/kg body weight of turmeric extract daily, respectively. After 7 days, the mice were sacrificed and anatomized. The results were then analyzed at the end of the IVF and IVM procedures.
The findings suggest that increase in concentration of turmeric significantly limits the level of maturation in somatic embryos. Moreover, the number of two and four-cell embryos within 24 and 48 hours after fertilization decreased in higher concentration of turmeric extract.
The extract of the turmeric plant could limit the maturation of primordial oocytes and reduce the number of resulting embryos. Therefore, caution should be accounted for its use.

Background and Diabetes mellitus is a metabolic disorder characterized by hyperglycemia, impaired insulin secretion or peripheral insulin resistance. Today, many herbal medicines are used in treatment of diabetes. Recently anti-diabetic properties of resveratrol are reported in some studies, but none have evaluated its anti-neuropathy properties and it's effect on Sirt1 gene expression. The aim of this research was to investigate the anti-diabetic and anti-neuropathy properties of resveratrol in mice.
BALB/c mice were divided into 6 groups (n=6 per group). A single dose of 200mg/kg subcutaneous injection of STZ was used to induce diabetes in all groups, except in negative controls which received normal saline. Treatment groups received metformin 300mg/kg and resveratrol 200mg/kg orally by gavage for 21 days. Then, their weight and blood sugar levels were determined and neuropathy test was conducted by hot plate apparatus. After killing and removing their livers and RNA extraction, Sirt1 gene expression was assayed by Real-time PCR.
According to the findings, resveratrol significantly reduced blood sugar level and improved peripheral neuropathy which were comparable with metformin (P Based on these results, resveratrol could be used alongside other treatments of diabetes to decrease the degree of insulin resistance and neuropathy.

Background and Transmucosal drug delivery unlike oral drug delivery has some advantages including deletion of first past effect and prevention of drug removal in gastro-intestinal tract and enzymatic flora. This study aimed at evaluating the effect of CMC, cerbomer and HPMC on Cinnamaldehyde release from formulation matrix and mucoadhesion of these formulations.
In this experimental research, nine formulations were selected and several tests including flowability, compressibility, hardness, assay, friability, swelling, and bioadhesive force were done.
According to the study, the angles of repose for all formulations were between 20.06±1.67 and 31.93±2.44. In addition, F5 and F6 had the most regular drug release patterns while F8 and F9 were found to have the fastest drug release. Maximum bioadhesive strength was observed in F8 and F9 but the minimum was observed in F3 and F4.
Drug delivery studies are of great importance, particularly for the drugs that do not have therapeutic efficacy in other routs of administration. According to current findings, HPMC induces the best formulation for transmucosal drug delivery.

Background and Hydatidosis is highly prevalent worldwide which mainly involves liver and lung. There are some drugs sensitive to the hydatid disease but surgery is still the most common form of treatment. Different chemical agents are used for inactivation of protoscolices during surgery but most leave serious side effects. Therefore, herbal extracts have received more attention as replacing agents that have acceptable scolicidal effects and no adverse effects. The aim of this study was to investigate the scolicidal effects of mixture of Artemisia, Eucalyptus and ginger extracts on hydatid cyst protoscolices in vitro.
Hydatid liver cysts isolated from sheep were collected from a slaughterhouse in Hamedan, Iran. The cysts fluid containing live protoscolices were aspirated aseptically. The effect of two concentrations of the methanolic extracts of the mixture (50 and 100 mg/ml) was investigated at 15 and 30 min. Viability of protoscolices was confirmed by 0.1% eosin staining. Data analysis was done applying Chi-square test.
The mixture of eucalyptus and ginger extracts showed acceptable scolicidal effects in which after 15 and 30 min exposure at 50 and 100 mg/ml concentrations it killed 97.24% and 100% of protoscolices, respectively.
This study showed that mixture of Eucalyptus and ginger had high scolicidal activity in vitro condition. Therefore, it could be used in surgical treatment of hydatid cyst after complementary researches.

Background and Previous research has shown that improving lower extremity muscle strength plays an important role in prevention of falls in older people. The aim of this study was to investigate the relationship between the changes of lower extremity muscle strength and postural control ability in elderly after a hydrotherapy program.
In a clinical trial, 30 elderly male were randomly selected and classified into intervention (mean age 65.4 years, mean height 169.3 cm, and mean weight 70.8 kg) and control groups (mean age 63.6 years, mean height 1688 cm, and mean weight 70.9 kg). The intervention group participated in an aquatic exercise program for 8 weeks while the control group had no intervention. Postural sway parameters and muscle strength were evaluated before and after the program using the Biodex balance system and hand held dynamometer (HHD) respectively. Pearson correlation test was used for data analysis (P≤0.05).
The results showed a significant relationship between the changes of plantar flexors muscle strength and postural control ability after the intervention (P0.05).
Compared with other lower extremity muscles, increase in plantar flexors muscle strength seems to have a major role in improving the postural control ability in elderly people. So, posterior muscles of the leg should be considered in planning exercises that aim at improving balance in older people.

Background and In developing countries, a high prevalence of musculoskeletal disorders is reported among drivers. However, there are few researches in Iran on this problem among suburban drivers. The present study aimed at investigating the prevalence of work-related musculoskeletal disorders and its related factors in suburban drivers in Mazandaran province.
This cross-sectional descriptive analysis was carried out in 1850 suburban drivers. Nordic Musculoskeletal Questionnaire and the demographic questionnaire were completed for all drivers. Logistic regression analysis was done in SPSS V22 applying Chi-square test.
The highest prevalence of musculoskeletal disorders in the past 12 months was found in neck (16.3%), knees (13.9%), and back and elbow (10.7%). Other factors such as age, work experience, smoking, previous accidents, and marital status showed a significant relationship with pain in various parts of the body (P This study showed a high prevalence of musculoskeletal disorders (especially in neck and knee) among suburban drivers in Mazandaran province. Such disorders could be easily prevented by designing ergonomic seats based on Iranian anthropometric sizes, doing stretch exercises, having sufficient rest, and trainings on correct sitting.

Background and Trauma scoring systems help physicians and nurses in recognizing the severity of trauma and its management. The purpose of this study was to investigate and compare the predictive ability of mortality rates of two trauma scoring systems (MGAP and GAP) in multiple trauma patients.
In this cross-sectional study, we used the data available in electronic records for trauma patients admitted to Rasht Poorsina Hospital, Iran. Demographic data, and GAP and MGAP (Mechanism, Glasgow Coma Scale, Age, and Pressure) scores for 1541 patients were extracted. Then, the ability of both scores in short-term (24 hours) and long-term (4-week) mortality prediction rates was analyzed using SPSS V21.
The surface areas under the curve ratio of ROC for predicting short-term mortality rates were 0.947 and 0.938, and for long-term mortality rates were 0.928 and 0.914 for GAP and MGAP, respectively (P Both GAP and MGAP could appropriately predict mortality rate without any significant difference. Therefore, these scores could be used as triage tools, and in predicting the severity of injuries and mortality.

Background and Postpartum depression is a serious preventable problem with various effects. According to previous studies, 44% of mothers with infants in neonatal intensive care units (NICU) show emotional symptoms such as depression and restlessness. Religion has always been regarded as a complementary approach and praying is usually used by people in harsh conditions. The aim of this study was to evaluate the role of prayer on depression in mothers with premature infants admitted to NICU.
In a clinical trial, 60 mothers of premature infants were randomly divided into a control group (n=30) and an intervention group (n=30). In the intervention group a prayer program was conducted for mothers one day after NICU admission for 7 days. Data was collected using a demographic questionnaire, SCL90 scale, DASS 21, and the Prayer Questionnaire. Data was analyzed in SPSS V11.5 applying Independent t-test, Mann-Whitney U, Paired t- test, and ANOVA.
The two groups were homogenous for all demographic factors (mother’s age, type of delivery, gravidity, number of childbirth, abortion, number of children, etc.) and that of the neonates (gender, Apgar Score, etc.) except infant birth weight (P=0.045). At the end of the intervention, there was no significant difference between the two groups in depression score (P=0.118) but one month later the scores revealed a significant difference between two groups (P=0.047).
Prayer can be effective in prevention of depression in mothers with premature neonates.

Background and Poor adherence is usually a major problem in hemodialysis patients. This study assessed the effect of telephone consultation and follow-up on treatment adherence and dialysis adequacy in hemodialysis patients.
This quasi-experimental study was carried out in Zanjan, Iran 2015-2016. In this study, 86 hemodialysis patients were selected via convenience sampling. Using random allocation method they were divided into two groups (experimental and control). The experimental group recieved two to three face-to-face consultations and a healthy diet at the beginning, and weeks four and eight of the study. Telephone follow up of patients was done for 12 weeks (28 times). Treatment adherence and dialysis adequacy were investigated in both groups (before the intervention, and weeks four, eight and twelve) using URR and Kt/V indices by administiring End- Stage Renal Disease Adherence Questionnaire (ESRD-AQ). Meanwhile, patients in control group received routine care and trainings. Data analysis was done applying Chi-square test, Fisher's exact test and Repeated measures ANOVA.
The mean age of participants was 52±11 years. Male patients included 55.8% of the cases. Dialysis adequacy, patients’ perception and understanding level, and behaviors of adherence in intervention group, in all stages, were significantly higher than those of the control group (P Counseling and telephone follow-up improved treatment adherence and dialysis adequacy, therefore, it is recommended in hemodialysis patients.

Background and Risk of burn is influenced by some factors including life conditions, lifestyle, and culture. Factors such as reduced physical strength, damaged protection mechanisms, taking various drugs leave elderly at more risk of burns. The aim of this study was to determine the factors associated with gender differences in incidence of burn in patients older than 59 years of age admitted to Sari Zare Hospital.
This cross-sectional study was done in patients older than 59 years of age who were admitted in Sari Zare Hosptal , a referral center for three provinces (Mazandaran, Golestan, Semnan), between 2013 and 2015. Participants were selected using census method. Data was collected using the patient's documents and a checklist for recording the information. Independent t test, Chi-square and Fisher's exact test were used in order to analyze the data.
A total of 169 patients was admitted in hospital including 85 males (50.3%). The mean age of patients was 70.4 ± 8.2. In urban areas the frequency of burns was higher in men than that in women (62.1% vs. 38.1%), while in rural areas this frequency was higher among women (68.2% vs 37.9%). We found a significant relationship between gender and place of residence, educational level, cause of burn, location of burn, and age group (P Our findings showed that incidence of burn is different in elderly men and women in terms of place of residence, education level, cause of burn, location of the burn, and age. Therefore, appropriate planning and prevention interventions are required.

Background and In order to increase the accountability of hospitals and ensuring proper medical treatments at any time of the day, physicians residing in non-administrative hours have active physical presence in the hospital and perform the diagnostic and therapeutic measures required. The purpose of this study was to assess the implementation of resident physician program in Mazandaran province, Iran.
A qualitative study was carried out in which the participants included 27 individuals from university authorities, hospital managers, and specialists. Data was collected by semi-structured interviews using purposeful and snowball methods and continued until data saturation. Then, transcription of interview data was done to determine the meaning units, coding, classification based on similarity and proportion, and identifying themes using content analysis.
According to the framework of the resident physician program, 13 primary themes and 47 secondary themes were extracted. This program improved the centers’ responses, indicators, and processes. But some themes such as finance, infrastructures, monitoring, implementation of the program, and payments to doctors were found as challenging issues requiring more attention.
Considering the opportunities and threats, and the strengths and weaknesses of the resident physicians program, current findings could provide managers and healthcare authorities with a more comprehensive approach to the present situation.

Background and Phthalic acid esters (PAEs) are a group of organic compounds that are used as additives in plastic industry. Among PAEs, dimethyl phthalate (DMP), the simplest compound in phthalates, is an aromatic pollutant that disturbs endocrine function. The aim of this study was to assess the effect of zero-valent iron nanoparticles (NZVI) on the DMP degradation.
NZVI were prepared by reduction of ferric chloride using sodium borohydride. Physical properties of nanoparticles were determined using Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM), X-ray Diffraction (XRD), and Vibrating Sample Magnetometer (VSM). Then, the effect of pH, DMP concentrations, the amount of NZVI, and contact time were investigated on DMP removal efficiency. Response surface methodology based on Box-Behnken was used to study the interaction between variables.
Maximum efficiency (99%) of DMP removal by NZVI was achieved in optimum conditions (pH=3, NZVI dosage =0.6 g/l, DMP concentration = 2 mg/l, and contact time= 65 min). The Box-Behnken analysis confirmed that pH and NZVI dosage have had the highest and lowest effect in the process of DMP removal by NZVI, respectively.
According to findings, NZVI in small amounts have a proper efficiency in DMP removal. Also, DMP degradation efficiency did not change much, after being used in five consecutive cycles of degradation reactions. This shows a potential application prospect of the synthesized NZVI in real water treatment.

Background and Enzymatic treatment, due to various benefits, has attracted many researchers since long time ago. Anionic detergents are one of the largest families of detergents that entered into the environment in recent decades. This study investigated the effect of horseradish peroxidase enzyme process on the removal of linear alkaline benzyl sulfonate (LAS) from aqueous solutions.
In an experimental study on a laboratory scale and in a batch reactor, the enzyme extracted from horseradish root was applied for removal of anionic detergent. Variables such as enzyme concentrations (0.5-2 U/mL), H2O2 (0.5-4 mg/l), detergent concentration (100-500 mg/L), and 0-60 min contact time were examined. Effluent concentration of detergent was measured according to the methylene blue method and spectrophotometric in 652 nm wavelength. At the end, kinetics of reactions were also studied.
The enzymatic activity of the extract from horseradish root was 3.15 U/mL, and had the highest activity at neutral pH. Removal efficiency was 98% in optimum condition (enzyme concentration 1.5 U/mL, H2O2 2 mg/L, pH 7.5, and 250 mg/l detergent). Gradual addition of reactants (enzyme and H2O2) increased the removal efficiency to 99.5%. The order of reaction of the enzymatic reaction followed the first-order reaction. The correlation coefficient (R2) was higher than 0.99 and mean constant reaction speed was 0.721 mol L-1min-1 (P≥0.05).
Enzymatic treatment by horseradish peroxidase can be used as an environmental friendly method in removal of pollutants such as surfactants.

Background and Gastric cancer is the second most common cause of cancer worldwide and despite huge advances in treatments, the chance of survival is very low even in surgery cases. Having a genetic predisposition plays an important role in cancer development. Polymorphisms in the NQO1(NAD(P)H Quinone dehydrogenase 1) gene could affect the activity of the gene and also the susceptibility to gastric cancer. The aim of this study was to evaluate the effect of the polymorphism of NQO1 gene on gastric cancer.
This case-control study was performed in 100 patients with gastric cancer and 100 healthy individuals as benchmarks. Genomic DNA was extracted from peripheral blood leukocytes. Then, genotyping for detecting NQO1 -609 C>T promoter gene polymorphism was carried out using PCR-RFLP. Data analysis was performed in MedCalc V9.
NQO1 rs1800566 allelic and genotypic frequencies were not significantly different between the patients and controls (P= 0.14¡ χ2= 2.16(
Screening of -609C>T NQO1 polymorphism was not found as a useful marker in detecting personal sensitivity to gastric cancer, therefore, would not be helpful in gastric cancer prevention and treatment processes.

Background and This study aimed at investigating the effect of hydroalchoholic extract of sumac (Rhus coriaria L.) on expression of passive avoidance learning in male rats.
In an experimental study, 24 adult Wistar rats weighing 230±20 gr were divided into three groups to receive solvent extract (DMSO), and 25 and 50 mg/kg of the sumac extract. Passive avoidance test was done using shuttle box after treatment. All treatments were conducted intraperitoneally, half hours before the test, on the second day (check expression). Data analysis was done applying one-way ANOVA and Tukey test (P The mice that received 25 mg/kg of sumac extract showed significant increase in the latency to enter the dark room compared to the group that received DMSO (P The hydroalcoholic extract of Rhus coriaria L. increased the expression of passive avoidance learning in rats.

Background and Studying the different diagnostic aspects of hydatid cysts (HC) plays a major role in early diagnosis and treatment. This study was conducted to evaluate the clinical and laboratory characteristics of HC cases operated in educational hospitals affiliated with Mazandaran University of Medical Sciences.
In this descriptive study, the records of all cases with HC (n=95) who underwent surgical treatment in two educational hospitals within 11 years (2004-2015) were studied and analyzed.
The patients were found to be 53.7% females, 67.4% living in rural areas, and 28.4% were aged 51-60 years old (P The present study showed that HC still remains a health problem in Mazandaran province, especially in rural areas.

Background and Opioid toxicity is a major problem in Iran. The aim of this study was to evaluate acute methadone toxicity in children admitted to hospital and identifying different patterns of this toxicity in children.
This cross-sectional study was conducted in 79 patients admitted to children emergency department in Mashhad Imam Reza Hospital whose methadone toxicity had been proved by urine analysis. The subjects were selected using convenient sampling. A researcher-made questionnaire was used consisting of child information. Data was analyzed applying T-Test, Chi-Square, Pearson correlation, Mann-Whitney, and Fisher's exact test.
The mean age of patients was 5±3.25 years old. The time elapsed since ingestion was 55 min. The common signs and symptoms were drowsiness (92.4%), bradypnea (83.5%), meiotic pupil (64.6%), vomiting (63.3%), and itching (43%). The most common laboratory findings included leukocytosis (41.9%), metabolic acidosis (30.7%), increased CRP (28.6%), hyperglycemia (11.7%), and hyponatremia (4%).
In order to reduce the incidence of methadone poisoning, addiction treatment centers are ought to provide their clients with appropriate trainings to prevent misuse of methadone, storage of methadone, and a fast referral to health centers in case of poisoning.